ESTRO 2024 - Abstract Book

S5881

RTT - Service evaluation, quality assurance and risk management

ESTRO 2024

624

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ARIA Visual Care Path for safety and quality assurance in a radiation oncology department

Federica Fragnoli 1 , Ilaria Bonaparte 1 , Rosilda Cuscito 1 , Chiara Indellicati 1 , Fiorella Cristina Di Guglielmo 1 , Giuseppe Sanfrancesco 1 , Christian De Pascali 1 , Alberto Aga 1 , Roberta Carbonara 1 , Alessia Surgo 1 , Valerio Davì 1 , Morena Caliandro 1 , Pietro Cardetta 1 , Maurizio Laricchia 1 , Rosalinda Parabita 1 , Piero Guida 1 , Maria Paola Ciliberti 1 , Alba Fiorentino 2 1 General Regional Hospital F Miulli, Radiation Oncology, Acquaviva delle Fonti, Italy. 2 LUM UNIVERSITY, Radiation Oncology, Casamassima, Italy

Purpose/Objective:

The patient care process within the radiation oncology clinic consists of several multidisciplinary steps that must be executed efficiently in the proper order to ensure safe, error-free treatment. Visual Care Path (VCP) is a workflow tool within the ARIA 11-18 Record and Verify System. The purpose of this study was to quantify the impact of VCP implementation on the metrics of efficiency and quality assurance in terms of risk of minor and major incidents.

Material/Methods:

Our multidisciplinary quality improvement team reviewed retrospectively the entire process of patient care (reports and VCP modules) to evaluate the patients’ flow. The follow steps were independently checked: Simulation step (Simulation report with patients’ photo; simulation photo); radiotherapy (RT) plan (dose prescription and dosimetric quality assurance -DQA-, patients’ RT documents, treatment notes for radiotherapists -RTT-); RT fractions (delivered versus planned, correct immobilization system, presence of surface guided RT -SGRT- procedures). With a sample size over 100 patients, a proportion ≤1% of major incidents had a 95% confidence interval with ≤5% while a proportion ≤5% had a 95% confidence interval with ≤10%. Descriptive statistics were calculated for the metrics of efficiency and quality assurance.

Results:

Radiation oncologists’ (RO), physicists’ and RTT’s compliance with timely completion of the Simulation Preparation VCP tasks was 100%: for all patients VCP was used. All the tasks evaluated were divided into major or minor incidents. The major ones are the following: no correct prescriptions of RT dose (according to guidelines); different immobilization systems during RT with respect to simulation, no SGRT data for patients positioning; not correct DQA for treatment plans; not completed RT as planned. Data on timeliness of task completion were collected for 105 patients (with a total of 945 tasks): all the patients’ reports were divided for treatment years (2019-2020 Period A; 2021 Period B; 2022-2023 Period C). Median age of patients was 65 years (range 40-92): 50 were female and 55 male. Thirty-six patients were treated in Period A, 34 in Period B and 35 patients in Period C. Regarding all incidents, 36 out 945 talks were reported (3.8%). Two major incidents were identified, in fact 2 patients did not received all the programmed fractions: 1 patient did not ended RT because he died, and another one because he has a grade 4 hematological toxicity so RO decide to suspend the treatment. These 2 cases were not considered error. Thus in terms