A Blinded, Prospective Study of Error Detection During Physician Chart Rounds in Radiation Oncology

Abstract

Peer review during physician chart rounds is a major quality assurance and patient safety step in radiation oncology. However, the effectiveness of chart rounds in detecting problematic treatment plans is unknown. We performed a prospective blinded study of error detection at chart rounds to clarify the effectiveness of this quality assurance step. Methods and Materials: Radiation Oncology Incident Learning System publications were queried for problematic plans approved for treatment that would be detectable at chart rounds. A resident physician, physicist, and dosimetrist collaboratively generated 20 treatment plans with simulated errors identical in nature to those reported to the Radiation Oncology Incident Learning System. These were inserted randomly into weekly chart rounds over 9 weeks, with a median of 2 problematic plans presented per chart rounds (range, 1-4). Data were collected on detection, attendance, length, and number of cases presented at chart rounds. Data were analyzed using descriptive statistics and univariable logistic regression with odds ratios. Results: The median length of chart rounds over the study period was 60 minutes (range, 42-79); median number of cases presented per chart rounds was 45 (range, 38-50). The overall detection rate was 55% (11 of 20). Detection rates were higher for cases presented earlier in chart rounds: 75% versus 25% of problematic plans were detected within 30 minutes of start of chart rounds versus after 30 minutes (odds Sources of support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Disclosures: Dr Roy Decker reports grants and personal fees from Merck, personal fees from Astra Zeneca, and personal fees from Regeneron outside the submitted work. Research data are stored in an institutional repository and select data may be shared upon request to the corresponding author as per institutional guidelines.

Assessing initial plan check efficacy using TG 275 failure modes and incident reporting

“…In a recent blinded study, Talcott et al demonstrated that traditional weekly chart rounds is only 55% effective at identifying simulated errors in presented treatment plans. 13 In response, Chera, Marks, and Potters suggest that prospective daily rounds are a potential solution, particularly in light of the technological shifts towards virtual meetings after the recent COVID-19 pandemic. 14 We found that Daily Contouring Rounds could detect errors associated with several high-risk failure modes including "FM1: Wrong or inaccurate MD contours," "FM3: Improper margins for PTV," and "FM 7: Wrong or inaccurate dosimetrist contours."…”

A quality improvement programme in radiotherapy using workflow audits

“…It is common practice for radiation oncologists to seek to minimise errors through the review of treatment plans at 'chart rounds' . In a prospective study, [11] detectable errors were inserted into treatment plans. However, these errors were detected during the review in only 55% of cases.…”

Radiation oncology peer review in Australia and New Zealand

“…A blinded prospective study of physician chart rounds reported a trend towards decreasing detection of errors with later presentation, with almost half of the problematic plans going undetected. 47 Cases should ideally be discussed prior to start of treatment as many recommendations occur earlier during the treatment workflow, 21,48,49 with major recommendations potentially being less likely to be implemented later in the workflow due to the amount of work required. 26 It may be more efficient to perform peer review in two stages, with radiotherapy planning only to commence after peer review of volumes.…”

“…However, when a larger number of cases are to be reviewed, consideration should be given to subspecialty‐specific meetings and shorter, more frequent meetings which are likely to be more effective than longer meetings. A blinded prospective study of physician chart rounds reported a trend towards decreasing detection of errors with later presentation, with almost half of the problematic plans going undetected 47 . Cases should ideally be discussed prior to start of treatment as many recommendations occur earlier during the treatment workflow, 21,48,49 with major recommendations potentially being less likely to be implemented later in the workflow due to the amount of work required 26 …”