Standardizing Physician Chart Rounds to Improve Error Detection in Radiation Oncology

Purpose: Peer review in weekly physician chart rounds is a major quality assurance and patient safety control in Radiation Oncology. Recent data suggests that this QA step has a poor rate of error detection (1). Within our department at an academic medical center, we initiated a prospective project to improve plan analysis during our weekly chart rounds meeting. Our study involved presenting plans with simulated errors into our chart rounds patients before and after implementing a standardized presentation script and case prioritization method. The goal of this project is to assess our departmental error detection rate during chart rounds and identify ways to improve our process.

Methodology: A literature review on error detection during weekly chart rounds in radiation oncology departments. Four types of errors were identified: 1. Wrong target 2. Normal structures not spared/less than ideal target coverage 3. Wrong dose or fractionation 4. Previous radiation dose to area not considered. To develop a baseline error detection rate, radiation oncology residents were randomly and anomalously assigned a total of 20 cases with simulated errors that were presented over a 3-month period. At the conclusion of this 3-month period, a standardized script was implemented for residents to follow when presenting cases. An additional 20 cases with simulated errors were then presented using this new standardized presentation method. We also implemented a prioritization method within our treatment planning system to present definitive cases at the beginning of chart rounds and palliative cases in the later portion of the meeting.

Results: There was no difference in the rate of error detection before and after the implementation of a standardized presentation script in our department. The baseline error detection rate was (13/20) 65% vs post-intervention (11/18) 61% p=0.39. The majority of errors were detected by attending physicians (62.5%), and the error was detected by the attending physician who planned the specific case 37.5% of the time. There was no difference in the rate of error detection by error type.

Conclusions: In our study, the rate of error detection in weekly chart rounds peer review was not improved by implementation of a standardized case presentation and prioritization method. It is clear that attending physician attendance and participation in peer review is essential for adequate plan review to ensure high quality treatment plans are delivered. Continued adaptation is needed to continue improvement in plan review methods to create an efficient system in which plans are carefully scrutinized without creating an unmanageable burden for physicians within radiation oncology departments.

References: 1. Talcott et al “A Blinded, Prospective study of Error Detection During Physician Chart Rounds in Radiation Oncology” Practical Radiation Oncology 2020 10,312-320