Development of an Updated Peer Review Process to Facilitate Communication and Improve Plan Quality and Safety

Purpose: The peer review process plays a critical role in Radiation Oncology by providing independent review of treatment plan quality and safety. The prior process at our institution did not have a mechanism to ensure prompt and accurate delivery of feedback. The purpose of the current study is to describe an updated peer review process that generates a score for each plan reviewed and provides a direct mechanism for conference feedback and attending response when appropriate.

Methodology: Swim lane process maps were generated using Visio and translated to Business Process Model and Notation (BPMN) for integration into an interactive online module used to track the status of unit operations from patient simulation through plan peer review. The updated peer review process breaks reviewed plans into four categories. Category 1 represents plan approval with no comment. Category 2 represents plan approval with comment that requires attending acknowledgement but does not require a response. Category 3 represents plan approval with comment that requires attending response with repeat plan review at a subsequent conference. Category 2 and 3 scores do not require plan revision. Category 4 is assigned to plans that are deemed to be missing critical information or those that are potentially unsafe. All plans assigned Category 4 during the conference are immediately unapproved. Plans that receive Category 2 through 4 generate an email sent directly to the attending physician to enable prompt comment review. Physician acknowledgement of feedback is recorded in the system. Changes made to contours or plans based on conference feedback is tracked for Category 2 and 3 plans. Between December 18, 2020 and November 19, 2021, 1,579 plans were reviewed and assigned scores based on conference feedback. Of note, plans that receive Category 2 feedback are assigned a Category 1 score if the attending is present during conference for discussion.

Results: Of the 1,579 plans reviewed during the period noted above, 1,490 (94%) received Category 1 scores. Seventy (4%) of the plans reviewed received Category 2 scores with 7 (10%) of those plans resulting in changes to contours and 9 (13%) of those plans resulting in plan revision. Sixteen (1%) plans received Category 3 scores with 6 (38%) of those plans resulting in changes to contours and 12 (75%) of those plans resulting in plan revision. Three (0.2%) plans received Category 4 scores.

Conclusions: The development of a peer review process that provides an automated mechanism for delivering conference feedback helps to further improve treatment plan quality by reducing the risk that the feedback arrives late or altered. The rate of contour and plan revision increased as peer review scores increased from Category 2 to Category 3 suggesting that the objective, granular feedback was effective at providing opportunities for plan improvement.

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