100% peer review in radiation oncology: is it feasible?

Abstract

Purpose Peer review has been proposed as a strategy to ensure patient safety and plan quality in radiation oncology. Despite its potential benefits, barriers commonly exist to its optimal implementation in daily clinical routine. Our purpose is to analyze peer-review process at our institution. Methods and materials Based on our group peer-review process, we quantified the rate of plan changes, time and resources needed for this process. Prospectively, data on cases presented at our institutional peer-review conference attended by physicians, resident physicians and physicists were collected. Items such as time to present per case, type of patient (adult or pediatric), treatment intent, dose, aimed technique, disease location and receipt of previous radiation were gathered. Cases were then analyzed to determine the rate of major change, minor change and plan rejection after presentation as well as the median time per session. Results Over a period of 4 weeks, 148 cases were reviewed. Median of attendants was six physicians, three in-trainingphysicians and one physicist. Median time per session was 38 (4-72) minutes. 59.5% of cases presented in 1-4 min, 32.4% in 5-9 min and 8.1% in ≥ 10 min. 79.1% of cases were accepted without changes, 11.5% with minor changes, 6% with major changes and 3.4% were rejected with indication of new presentation. Most frequent reason of change was contouring corrections (53.8%) followed by dose or fractionation (26.9%). Conclusion Everyday group consensus peer review is an efficient manner to recollect clinical and technical data of cases presented to ensure quality radiation care before initiation of treatment as well as ensuring department quality in a feedback team environment. This model is feasible within the normal operation of every radiation oncology Department.

The impact of radiation therapist‐led structured peer review meetings on compliance to Radiation Oncology Practice Standards

“…19 Similarly, a further study also highlighted daily conferences used for peer review amongst all treating ROs. 20 All cases (total of 148) were presented with an average session time of 38 min and majority of cases presented in 1-4 min. They found 80% of cases were acceptable and the most common reason for changes was contouring corrections (53.8%).…”

Three discipline collaborative radiation therapy (3DCRT) special debate: Peer review in radiation oncology is more effective today than 20 years ago

“…10 When contours are reviewed, issues with contouring account for over half of the major changes requested during peer review. 21,28 This indicates a potential mismatch between the focus of some current peer review practices and the clinically impactful 29 Reports suggest that participants are less likely to recommend changes to treatment plans once the patient has started treatment, likely due to an array of different cognitive biases and to avoid increasing workflow burden. 9,12,30 Even when changes are recommended, they are more likely to be implemented if treatment has not yet started.…”

“…There are examples in the literature of prospective peer review being successfully implemented, 12,14,21,28,53 as the opposition has indicated, but this is not the current standard in the field. Statistics presented in the literature within the last 10 yr indicate that less than 40% of treatment plans are reviewed prior to treatment start.…”

“…48 Although the 10% plan modification rate resulting from retrospective peer review highlights the importance of the activity in providing quality patient care even when done retrospectively, this rate more than doubles in publications where peer review is done earlier in the treatment process. 14,21,28,53 This emphasizes once again that prospective peer review is superior and suggests that peer review in its current form is not as effective. Even with the increased rate of problem detection in prospective peer review, it is difficult to discern its absolute effectiveness as the true number of problematic plans is unknown.…”

“…Despite the challenging nature of peer review implementation, it is more feasible now than ever before within the standard operations of every radiation oncology department. 21 3.B | Laura Padilla, PhD; Erina Vlashi, PhD; Patrizia…”