Evaluation of the Type and Frequency of Errors Discovered During Routine Secondary Patient Chart Review

• Michael T. Hardin

  Department of Radiation Oncology, Division of Medical Physics, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA

• Amy S. Harrison

  Department of Radiation Oncology, Division of Medical Physics, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA

• Virginia L. Lockamy

  Department of Radiation Oncology, Division of Medical Physics, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA

• Jun Li

  Department of Radiation Oncology, Division of Medical Physics, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA

• Cheng Peng

  Department of Radiation Oncology, Division of Medical Physics, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA

• Peter Potrebko

  Department of Radiation Oncology, Florida Hospital Waterman Cancer Institute, Tavares, FL, USA

• Yan Yu

  Department of Radiation Oncology, Division of Medical Physics, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA

• Laura Doyle

  Department of Radiation Oncology, Division of Medical Physics, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA

• Junsheng Cao

  Department of Radiation Oncology, Division of Medical Physics, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA

Purpose: Desire to improve efficiency and throughput inspired a review of the frequency and scope of our physics chart check procedures. Departmental policy mandates review of a patient’s treatment plan prior to port-filming, after first treatment and “weekly” every 3-5 fractions. This study examined the effectiveness of the “after-first” physics check with respect to improving patient safety and clinical efficiency.Methods and Materials: A shared spreadsheet was created to record errors discovered during patient-specific chart review following the first fraction of treatment and before the second fraction. First, entries were recorded and categorized from August 2014 through February 2015. Frequencies were assessed month-to-month. Next, utilizing thes e results, a continuous quality improvement (CQI) process following Deming’s Plan-Do-Study-Act (PDSA) methodology was generated. The first iteration of this PDSA was adding a dose tracking checklist item in the pre-treatment plan check assessment. A two-sided Fisher’s exact test was used to determine if there was a nonrandom association between the checklist implementation and incidence of dose tracking errors.Results: Analysis of recorded errors indicated an overall error rate of 3.4% over the 13 month period. The majority of errors related to discrepancies in documentation, followed by prescription, plan deficiency, and dose tracking-related errors. A two-sided Fisher’s exact test revealed a statistically significant decrease in dose tracking-related errors after implementing the checklist item (p = 0.0322, significance level = 0.05). Conclusions: This work indicates that this redundant secondary check is an effective QA process in our department. The first month spike in rates could be due to the Hawthorne/observer effect, but the consistent 3% error rate suggests the need for continuous quality improvement and periodical re-training on errors noted as frequent to improve awareness and quality of the initial chart review process, which may lead to improved treatment quality, patient safety and increased clinical efficiency.

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