Ten-year results of quality assurance in radiotherapy chart round

Abstract

BackgroundThe Royal Australian and New Zealand College of Radiologists (RANZCR) initiated a unique instrument to audit the quality of patient notes and radiotherapy prescriptions. We present our experience collected over ten years from the use of the RANZCR audit instrument.MethodsIn this study, the results of data collected prospectively from January 1999 to June 2009 through the audit instrument were assessed. Radiotherapy chart rounds were held weekly in the uro-oncology tumour stream and real time feedback was provided. Electronic medical records were retrospectively assessed in September 2009 to see if any omissions were subsequently corrected.ResultsIn total 2597 patients were audited. One hundred and thirty seven (5%) patients had one hundred and ninety nine omissions in documentation or radiotherapy prescription. In 79% of chart rounds no omissions were found at all, in 12% of chart rounds one omission was found and in 9% of chart rounds two or more omissions were found. Out of 199 omissions, 95% were of record keeping and 2% were omissions in the treatment prescription. Of omissions, 152 (76%) were unfiled investigation results of which 77 (51%) were subsequently corrected.ConclusionsReal-time audit with feedback is an effective tool in assessing the standards of radiotherapy documentation in our department, and also probably contributed to the high level of attentiveness. A large proportion of omissions were investigation results, which highlights the need for an improved system of retrieval of investigation results in the radiation oncology department.

Radiation Oncology Quality Assessment Tool: A proposal for a new audit tool in modern radiation oncology

“…Patient comorbidities or compliance will sometimes necessitate deviation from accepted guidelines . Resources and clerical issues can also impact on documentation and numbers of patients discussed at multidisciplinary meetings . It is also important to note that non‐adherence to guidelines does not necessarily mean that the patient received suboptimal care, as long as the plan can be justified and has been peer‐reviewed .…”

“…This was a retrospective audit, and it is well known that clinical audits are best completed prior to the patient starting treatment so that any potential errors can be picked up . Any future studies using this audit tool should be conducted prospectively and include an assessment of how often the audit triggered a change to management and if it had an effect on treatment outcomes.…”

“…Manual assessment of this type of documentation seems like a duplication given the checks in place for this through electronic prescribing processes. Similarly, all pathology and imaging is now easily accessible as electronic reports, so this was not specifically included in the algorithm, unlike the RANZCR PRAT . However, we would recommend that departments ensure that they have a reliable automated system prior to using this tool.…”

“I sleep better at night:” How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs

“…9 Several authors have described the potential of peer review to indirectly improve quality of care in radiotherapy, both at the general practice level 1;10 or within specific institutions. [11][12][13][14][15][16] In addition, surveys of Canadian ROPs have provided quantitative evidence regarding the perceived benefits of peer review. 7;8 A recent pan-Canadian survey showed that ROPs rated the indirect benefits of peer review as highly important, including the impact of peer review on reducing variation in practice, improving treatment policies, and contributing to continuing professional education.…”

Making electronic health records support quality management: A narrative review

“…Like paper records, EHR systems may suffer from data inaccuracy or even erroneous data. A study of radiotherapy service suggests that real-time audit with feedback is an effective tool in assessing the standards of documentation [39]. More generally, based on a comprehensive expert survey, it has been argued that EHR systems should be certified in order to ensure their quality [40], though the evidence for the utility of this proposal is not very clear.…”