Does Peer-Review of Radiation Treatment Plans Impact Clinical Care? A Systematic Review of the Literature

Abstract

lay solely with departmental leadership to follow-up on and address incidents. A few still expressed fear of retribution, describing being told not to document an incident by a co-worker. Other barriers such as time and accessibility were commonly described. Learning was often described as increased awareness, resulting from expanded communication, and less frequently from explicit teaching. Practice improvement was rarely perceived as learning. Conclusion: Overall, the opportunity to influence patient safety was perceived as highly relevant by participants. Barriers included logistics and inadequate feedback, but also, despite marked progress, some persistence of hierarchical beliefs and behaviors more consistent with "shame and blame" culture. These results identify the need for procedural, cultural, and educational changes, e.g., web access, more specific and timely feedback to clearly demonstrate positive outcomes, and more transparency, to be made within the department so that all staff members continue to feel comfortable reporting incidents and meaningfully engaging in the system.

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

“…However, available data suggest that the most common changes during chart rounds are related to target volume delineation (45%), dose prescription or written directives (24%), and nontarget volume delineation or normal tissue sparing (7%). 10 In this study, 13 of 20 of the scenarios were within those 3 targets for peer review. The remainder of cases had errors usually caught earlier in the workflow (eg, physics check).…”

“…A median of 2 problematic plans were presented weekly (range, 1-4). In 75% of problematic plans, the severity score 19 was >7 corresponding to expected potentially serious toxicity or tumor underdose (range, 4-10), and in 75% of problematic plans the detectability score 19 was <7 corresponding to a !95% expected likelihood of detection (range, [3][4][5][6][7][8][9][10].…”

“…Errors reflecting the 3 most common targets of plan modification (target volume delineation, dose prescription or written directives, and nontarget volume delineation or normal tissue sparing) made up 13 of 20 plans. 10 The remaining 7 plans had errors usually caught earlier in the workflow (problem with imaging used for treatment planning, inadequate target coverage, previous treatment not considered).…”

“…Physician chart rounds should function as a broad and effective net for error detection in the radiation oncology workflow. Peer review results in recommendations for modifications to the treatment plan in at least 10% of cases, 10,11 further underscoring its utility.…”