ESTRO 2023 - Abstract Book

S143

Saturday 13 May

ESTRO 2023

identify the potential for European Union action on quality and safety in the three core project specialties, radiology, radiotherapy and nuclear medicine. By a literatura review, European Surveys to Scientific and Proffessional National Societies, Regulatory Bodies and Health National Authorities and personal interviews to experts in the field, we assessed the current status of clinical audits and drafted a set of recommendations to facilitate and improve the uptake of clinical audits across Eruope. QuADRANT identified that developments in national clinical audit infrastructure are required in order to successfully implement clinical audits as a standard of practice in a large scale. National professional societies will be pivotal in improving clinical audit implementation, but resource allocation and national prioritisation of clinical audit are needed in many countries. Lack of staff time and expertise are also barriers. Enablers to enhance clinical audit participation are not widely employed. Development of hospital accreditation programmes can facilitate clinical audit uptake. An active and formalised role for patients in clinical audit practice and policy development is highly recommended. We found that there is persisting variation in European awareness of BSSD clinical audit requirements. Work is needed to improve dissemination of information on the legislative requirements relating to clinical audit in the BSSD and in relation to inspection processes to ensure these include clinical audit and that they encompass all clinics and specialties involved in medical applications using ionising radiation. In conclusion QuADRANT provides an important step towards enhancing clinical audit uptake and implementation across Europe. Clinical auidts are pivotal in the standarisation of practice accross Europe which will result in improving access to standard of care practice, patient safety and outcomes. SP-0205 B-QUATRO clinical audits: A Belgian success story? A. Vaandering 1 , A. Batamuriza Almasi 2 , A. Vermylen 3 , B. Vanderstraeten 4 , C. Weltens 5 , C. Meunier 6 , D. Verellen 7 , K. Vandeputte 8 , L. Van den Berghe 4 , M. Van Dycke 9 , M. Tomsej 10 , N. Linthout 11 , N. Deman 12 , P. Van Houtte 13 , P. Thysebaert 14 , S. Cucchiaro 15 , S. Derycke 16 , V. Remouchamps 6 , P. Bijdekerke 17 , P. Scalliet 18 , S. Vynckier 18 , Y. Lievens 4 , F. Vanhoutte 4 , E. Goemaere 19 1 Cliniques Universitaires St Luc, Radiation Oncology department, Brussels, Belgium; 2 EpiCura, Radiation Oncology department, Baudour, Belgium; 3 Iridium Netwerk, Radiation Oncology department, Antwerpen, Belgium; 4 UZ Gent, Radiation Oncology Department, Gent, Belgium; 5 UZ Leuven, Radiation Oncology Department, Leuven, Belgium; 6 CHU UCL Namur, Radiation Oncology Department, Namur, Belgium; 7 Iridium Netwerk, Radiation Oncology Department, Antwerpen, Belgium; 8 CH Mouscron, Radiation Oncology Department, Mouscron, Belgium; 9 (Cliniques St Jean), Radiation Oncology Department, Brussels, Belgium; 10 CHU Charleroi, Radiation Oncology Department, Charleroi, Belgium; 11 Onze Lieve Vrouw Ziekenhuis, Radiation Oncology Department, Aalst, Belgium; 12 AZ St Lucas, Radiation Oncology Department, Gent, Belgium; 13 Institut Jules Bordet, Radiation Oncology Department, Anderlecht, Belgium; 14 Odisee, Medische Beeldvorming en Radiotherapie, Brussels, Belgium; 15 CHU Liège, Radiation Oncology Department, Liège, Belgium; 16 AZ Groeninge, Radiation Oncology Department, Kortrijk, Belgium; 17 UZ Brussels, Radiation Oncology Department, Jette, Belgium; 18 Université Catholique de Louvain, Radiation Oncology Department, Brussels, Belgium; 19 AZ Delta, Radiation Oncology Department, Roeselare, Belgium Abstract Text The potential benefits of clinical audits are multiple and have the overall aim of encouraging continuous quality improvement through the implementation of corrective actions based on the recommendations emitted by the audits. The organisation of these audits have become mandatory in European Member states through the publication of the 2013 European Medical Exposure Directive (Council Directive 2013/59/Euratom) which states that Member States are required to ensure that clinical audits are carried out according to national procedures [1]. In Belgium, this mission was implicitly entrusted to the College for Physicians in Radiation Oncology (“The College”). It was decided to use the existing IAEA QUATRO (Quality Assurance Team for Radiation Oncology) methodology and audit tool in order to carry out peer-reviewed clinical audits of all radiotherapy (RT) departments from 2011 to 2015 included [2]. Following this first cycle of audits, the QUATRO tool was reviewed taking into account the Belgian context, the evolution of standards of care and technology. In addition, certain parts of the QUATRO audits were developed in order to optimize the evaluation of quality management systems. Following this review, the adapted version of QUATRO –called B-QUATRO – has then been used to carry out a second cycle of clinical audits of all RT departments. This started in 2017 and will end beginning of 2023 - the audits having been interrupted due to COVID-19. The organisation of these clinical audits have led to useful as well as relevant sets of commendations and recommendations that have been shared with the audited radiotherapy departments through audit reports [3]. The success of the implementation of these national clinical audits has been aided by a number of favouring elements such as the pre-existence of the IAEA QUATRO document, the existence of national quality oriented platform composed of radiotherapy professionals (“the College”), a limited number of RT department (n= 24) as well as a limited budget allowing for the reimbursement of costs incurred by the auditors. The existence of a culture of quality, safety and multidisciplinary respect within the RT departments have also played a role in the success of the audits. Certain challenges also need to be taken into account when implementing clinical audits. This includes the need to regularly review the quality criteria stipulated within the auditing tool (BQUATRO) - this in accordance with the evolution of what is considered to be best practice while also taken into account the findings of the previous audits. Another challenge is the reliance of these peer- reviewed audits on professional active RT professionals who need dedicated time and necessary skills to carry out the audits. While keeping in mind that the peer review nature of the audits are of uttermost value leading to comprehensive audits and favouring the willingness of the departments to participate in the audits. Finally, it is also necessary to ensure that radiotherapy specific clinical audits – such as B-QUATRO - remain complimentary to hospital accreditation systems. References [1] Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. n.d. [2] Izewska J, Coffey M, Scalliet P, Zubizarreta E, Santos T, Vouldis I, et al. Improving the quality of radiation oncology : 10 years ’ experience of QUATRO audits in the IAEA Europe Region. Radiotherapy and Oncology 2018;126:183– 90. https://doi.org/10.1016/j.radonc.2017.09.011.