Impact of a real‐time peer review audit on patient management in a radiation oncology department

Abstract

In September 2006, the Royal Australian and New Zealand College of Radiologists (RANZCR) endorsed the modified Peer Review Audit Tool (PRAT). We aimed to assess the feasibility of using this tool in a busy radiation oncology department using an electronic medical record (EMR) system, identify areas of compliance and assess the impact of the audit process on patient management. Fortnightly random clinical audit was undertaken by using the revised RANZCR PRAT in the departments of radiation oncology at Liverpool and Macarthur Cancer Therapy Centres (LCTC and MCTC). Following audit of the EMR, treatment plans were audited by peer review. Data were collected prospectively from June 2007 to June 2008. Audits were carried out on 208 patients. Behaviour criteria were well documented in the EMR, but scanning of histology and medical imaging reports did not occur in up to a third of cases. With electronic prescriptions, treatment prescription errors were rare. In total, 8 (3.8%) out of 208 patients had a change to management recommended. Variability in interpretation of PRAT 'protocol/study' criteria was identified. We found that real-time audit is feasible and effective in detecting both issues with documentation in the EMR, and a small number of patients in whom a change to management is recommended. Recommendations have been made in order to continue to improve the audit process including documentation of any changes recommended and whether the recommended change occurred.

Predictors of breast radiotherapy plan modifications: Quality assurance rounds in a large cancer centre

“…In a University of North Carolina Hospitals study of 105 patients, 3% and 5% of their reviewed cases received a ''major'' or a ''minor change'' status respectively, after weekly chart rounds [18]. Using the aforementioned RANZCR audit tool, 8 of 208 (3.8%) of reviewed patients had a recommended change in management, including 6 (2.9%) with target volume coverage, 1 (0.5%) with dose prescription, and 1 (0.5%) involving a fractionation schedule [11]. At the Cancer Institute in Singapore, a post-treatment audit of 118 patients demonstrated that in $5% of instances, the medical decisions regarding dose, treatment intent, or fractionation were deemed ''controversial'' or ''concerning'' [19].…”

“…This rate was independent of the RO's experience, but was an important process for continuous quality improvement. An Australian study, using the Royal Australian and New Zealand College of Radiologists (RANZCR) auditing tool, reported a similar correction rate of 3.8% [11]. Likewise, a Canadian study reported that 1% of its reviewed plans required modification [12].…”

A survey of radiation treatment planning peer-review activities in a provincial radiation oncology programme: current practice and future directions

“…As modern radiotherapy planning and delivery systems become increasingly sophisticated and complex, quality-assurance procedures must also evolve in order to ensure that consistently effective and safe therapy is delivered 1 2. Although much of the attention regarding the safety of radiotherapy has focused on the relationship between quality-assurance practices and critical high-profile dose delivery incidents, quality-assurance programmes are also necessary to minimise the potential for less severe ‘errors’, or inappropriate variations in processes or practice, that represent threats to the overall quality of radiotherapy care 3.…”

“…Although much of the attention regarding the safety of radiotherapy has focused on the relationship between quality-assurance practices and critical high-profile dose delivery incidents, quality-assurance programmes are also necessary to minimise the potential for less severe ‘errors’, or inappropriate variations in processes or practice, that represent threats to the overall quality of radiotherapy care 3. While RO has a long history of high-quality technical assurance (eg, processes designed to ensure technical quality, such as valid machine calibration, laser setup calibration and accurate treatment planning systems), the more subjective decisions made by attending physicians are less routinely subject to quality-assurance processing, and are the target of peer review 2. Clearly, both high-quality technical processes and high-quality technical medical care are required to optimise patient outcomes.…”

Impact of the introduction of weekly radiotherapy quality assurance meetings at one UK cancer centre

“…[10][11][12][13] At the Royal Wolverhampton Hospital, Wolverhampton, UK, a weekly RTQA was commenced in October 2011. The RTQA is a considerable investment in resources by the trust.…”