ESTRO 2024 - Abstract Book

S177

Brachytherapy - GI, paediatric, miscellaneous

ESTRO 2024

our MRI-based rectal brachytherapy process using the classical quality improvement methodology, reducing the delays between planning and treatment delivery.

Material/Methods:

A multidisciplinary team was formed under the quality improvement cell, including a radiation oncologist, radiologist, medical physicist, specialist technologist and nurse. We aimed to reduce the number of days gap between the planning MRI day to the treatment delivery day from a median (Dmed) and mean (Dmean) of 14 and 15 days, respectively, to <1 day each (primary goal) and to increase the number of same-day treatments (D0%) from currently 0% to at least 70% (secondary goal) in next three months (by 31st Jan 2023). The balancing measure was treatment errors or delays. Several factors were identified through Gemba walks, and a cause-and-effect diagram (fishbone) was created. The inconsistent delays in the planning MRI, poor inter-departmental coordination, non-availability of rectal enema in the early morning, non-availability of medical physicist and planning system in late afternoons, poor communication within and between the care teams, and nonstandard patient arrival times were identified as the key causes for the delay. Based on this, improvement opportunities (key drivers) were identified, and Plan-Do-Study-Act (PDSA) cycles were implemented. The outcome measure was measured from the Day of planning MRI to the Day of brachytherapy treatment, obtained from timestamps in the electronic health record. The outcomes during the sustenance phase from February 2023 - September 2023 (eight months) are also recorded and reported. The Baseline data from 31 patients showed Dmed, Dmean & D0% of 14, 15 & 0%, respectively. The first PDSA cycle included patient reminders to arrive at specific times, improved communication, & coordination with the MRI team for a fixed scheduled slot in the morning (8-10 am). The second PDSA cycle included the availability of the rectum enema facility in the early morning (6-8 am), strengthening coordination with the MRI team & re-enforcing the availability of a medical physicist and planning system in the early afternoon (10-12 noon). The post implementation data at PDSA 1 and 2 from 14 patients each were analysed. The Dmed, Dmean & D0% improved to 3, 3 days and 35.7%, respectively, post-change for PDSA 1. This further bettered to zero, 0.2 days and 78.9%, respectively, post-change for PDSA 2. The balancing measure remained the same. A sustained shift in the process was apparent on a control run chart (Figure 1A: D_mean & D_Median; Figure 1B: D0%), suggesting sustainability. Further in the sustenance phase, the Dmed, Dmean and D0% were maintained at 0.3, 0 days and 74%, respectively, for over 42 patients. Results: