- Quality Management of Treatment Planning

2012 ◽  
pp. 206-219
Keyword(s):  
Quality Management ◽  
Treatment Planning

Policy and procedure manuals: Does existence imply standardization in practice?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 275-275
Author(s):  
Ajay Kapur ◽  
David Barbee ◽  
Yijan Cao ◽  
Abolghassem Jamshidi ◽  
Louis Potters
Keyword(s):  
Patient Safety ◽  
Quality Management ◽  
Treatment Planning ◽  
Management Team ◽  
Kappa Statistics ◽  
Specific Policy ◽  
Policy Statements ◽  
Standards And Guidelines ◽  
Mere Existence ◽  
Policy And Procedure

275 Background: Patient safety organizations recommend the use of policy and procedure manuals (PPM) to effectuate standards and guidelines in practice. In this work we explored inter-physicist variability in the interpretation of five established physics policies amongst physicists in our department. Methods: The policies for treatment planning, 2nd physics checks, 1st day physics checks, weekly chart checks and final physics checks were reviewed by members of the quality management team in our department. Specific definitive statements were extracted into a spreadsheet and provided to 11 physicists and 6 dosimetrists. The intent was to obtain individual responses on adherence to the statements and thereby assess the level of standardization in perception and practice amongst the staff using free-margin kappa statistics. The responses were limited to affirmation, rejection or non-applicability. A total of 732 responses were assessed. Results: Based on the Landis-and-Koch criteria for interpretation of kappa values, the consistency amongst the respondents varied from moderate (0.40-0.60) to good (0.60-0.80). The kappa scores for the statements assessed were 0.56 for treatment planning, 0.64 for second physics check, 0.70 for the first day physics check, 0.54 for the weekly physics check and 0.73 for the final physics check. Conclusions: Validating the effectiveness of PPMs by measuring uniformity in staff interpretation is an important step in establishing their effectiveness. Mere existence of a PPM may not be sufficient. This work demonstrated reasonable uniformity of interpretation of existing policies, but underscored the need for further improvement. The review of specific policy statements with weaker consensus may lead to more effective revisions and in-servicing to enhance clarity and reduce ambiguity, re-testable using the same approach. Absence of validation will tend to retain ambiguity, thereby rendering the policy not as effective as it could be.

1522: Utility of Preoperative 3-D Reconstruction of Pelvic Vasculature using Multi-Detector Spiral CT Scanning in Treatment Planning for Robotic Prostatectomy

2005 ◽  
Vol 173 (4S) ◽  
pp. 412-412
Author(s):  
Ashutosh Tewari ◽  
Assaad El-Hakim ◽  
Peter N. Schlegel ◽  
Mani Menon ◽  
Deirdre M. Coll
Keyword(s):  
Treatment Planning ◽  
Ct Scanning ◽  
Spiral Ct ◽  
Robotic Prostatectomy

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

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