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Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review

Purpose: The Joint Commission has encouraged the healthcare industry to become “High Reliability Organizations” by “Chasing Zero Harm” in patient care. In radiation oncology, the time point of quality checks determines whether errors are prevented or only mitigated. Thus, to “chase zero” in radiatio...

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Autores principales: Vijayakumar, Srinivasan, Duggar, William Neil, Packianathan, Satya, Morris, Bart, Yang, Chunli Claus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491674/
https://www.ncbi.nlm.nih.gov/pubmed/31069170
http://dx.doi.org/10.3389/fonc.2019.00302
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author Vijayakumar, Srinivasan
Duggar, William Neil
Packianathan, Satya
Morris, Bart
Yang, Chunli Claus
author_facet Vijayakumar, Srinivasan
Duggar, William Neil
Packianathan, Satya
Morris, Bart
Yang, Chunli Claus
author_sort Vijayakumar, Srinivasan
collection PubMed
description Purpose: The Joint Commission has encouraged the healthcare industry to become “High Reliability Organizations” by “Chasing Zero Harm” in patient care. In radiation oncology, the time point of quality checks determines whether errors are prevented or only mitigated. Thus, to “chase zero” in radiation oncology, peer review has to be implemented prior to treatment initiation. A multidisciplinary group consensus peer review (GCPR) model is used pre-treatment at our institution and has been successful in our efforts to “chase zero harm” in patient care. Methods: With the GCPR model, policy-defined complex cases go through a treatment planning conference, which includes physicians, residents, physicists, and dosimetrists. Three major plan aspects are reviewed: target volumes, target and normal tissue dose coverage, and dose distributions. During the review, any team member can ask questions and afterwards a group consensus is taken regarding plan approval. Results: The GCPR model has been implemented through a commitment to peer review and creative conference scheduling. Automated analysis software is used to depict color-coded results for department approved target coverage and dose constraints. About 8% of plans required re-planning while about 23% required minor changes. The mean time for review of each plan was 8 min. Conclusions: Catching errors prior to treatment is the only way to “chase zero” in radiation oncology. Various types of errors may exist in treatment plans and our GCPR model succeeds in preventing many errors of all shapes and sizes in target definition, dose prescriptions, and treatment plans from ever reaching the patients.
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spelling pubmed-64916742019-05-08 Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review Vijayakumar, Srinivasan Duggar, William Neil Packianathan, Satya Morris, Bart Yang, Chunli Claus Front Oncol Oncology Purpose: The Joint Commission has encouraged the healthcare industry to become “High Reliability Organizations” by “Chasing Zero Harm” in patient care. In radiation oncology, the time point of quality checks determines whether errors are prevented or only mitigated. Thus, to “chase zero” in radiation oncology, peer review has to be implemented prior to treatment initiation. A multidisciplinary group consensus peer review (GCPR) model is used pre-treatment at our institution and has been successful in our efforts to “chase zero harm” in patient care. Methods: With the GCPR model, policy-defined complex cases go through a treatment planning conference, which includes physicians, residents, physicists, and dosimetrists. Three major plan aspects are reviewed: target volumes, target and normal tissue dose coverage, and dose distributions. During the review, any team member can ask questions and afterwards a group consensus is taken regarding plan approval. Results: The GCPR model has been implemented through a commitment to peer review and creative conference scheduling. Automated analysis software is used to depict color-coded results for department approved target coverage and dose constraints. About 8% of plans required re-planning while about 23% required minor changes. The mean time for review of each plan was 8 min. Conclusions: Catching errors prior to treatment is the only way to “chase zero” in radiation oncology. Various types of errors may exist in treatment plans and our GCPR model succeeds in preventing many errors of all shapes and sizes in target definition, dose prescriptions, and treatment plans from ever reaching the patients. Frontiers Media S.A. 2019-04-24 /pmc/articles/PMC6491674/ /pubmed/31069170 http://dx.doi.org/10.3389/fonc.2019.00302 Text en Copyright © 2019 Vijayakumar, Duggar, Packianathan, Morris and Yang. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Vijayakumar, Srinivasan
Duggar, William Neil
Packianathan, Satya
Morris, Bart
Yang, Chunli Claus
Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review
title Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review
title_full Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review
title_fullStr Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review
title_full_unstemmed Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review
title_short Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review
title_sort chasing zero harm in radiation oncology: using pre-treatment peer review
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491674/
https://www.ncbi.nlm.nih.gov/pubmed/31069170
http://dx.doi.org/10.3389/fonc.2019.00302
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