A quality improvement programme in radiotherapy using workflow audits

Abstract

Evaluation of the quality of healthcare depends on information from three categories, namely facility structures, operation of processes, and outcomes of the health services. [1,2] Quality assurance programmes and audits for the accreditation of facilities in medicine and oncology largely evaluate the first category, i.e. facility structures and the availability of policies. [3][4][5][6][7][8] There has been progress in recording clinical data through commercial electronic information systems, e.g. the Mosaiq and Aria systems in oncology. These allow for the improved measurement of processes, such as the completeness of clinical data, the performance of professional tasks and the use of checklists as part of routine care. The inclusion of these in audits will help the development of quality improvement programmes by upholding high standards and reducing technical and clinical errors.Radiotherapists undertake the administration of radiotherapy (RT) and maintain electronic records of treatments. They form an interdependent multidisciplinary team together with medical physicists and radiation oncologists for the safe and effective administration of RT to patients.In 2016, an RT workflow audit was developed within an accountable care organisation, Icon Oncology, and implemented in their 28 units, with a total of 32 linear accelerators. In July 2020, an online survey of the user experience of the audit was held.The RT workflow audit and the subsequent online survey findings are described and evaluated in this report, and their relevance to quality improvement programmes in multidisciplinary teams is discussed. Methods The RT workflow auditThe RT workflow audit consisted of a review of patient records that were stored in a commercial information system (Mosaiq; Elekta, Sweden). The RT audit measured documented completion of a list of task items that were developed by a radiotherapist task team in 2016. They included clinical data, the completion of professional tasks, and the use of checklists to be used in routine practice. The total number of task items on the audit document was 90, and the number that were scored was 64. The task items not scored were aspirational and not part of routine care. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.