ASTRO 2015

Improving the consistency of radiation oncology processes

Dr John Suh - Cleveland Clinic, Cleveland, USA

Could you outline what the quantitative metrics and automatic auditing program (QMAP) does?

One of my colleagues presented our data on an automated system to help maximise workflow within a radiation oncology department. It’s really based on our experience that in order to have best quality care to provide the most efficient care possible we need to have a process in place to help project when certain tasks would not be done on time. So what we did is we created the software called QMAP which stands for quantitative measurements and automatic assessment program which allows us to figure out when certain tasks are not being done on time. What this programme allows us to do is to help determine when deviations may occur and to try to prevent those deviations from occurring so it doesn’t reach the patient.

So the three areas that we focussed on were on late chart arrivals, which we defined as charts arriving more than four hours to the machine. We also looked at the checking daily CT scans and also looking at weekly visits for on treatment visits. What the QMAP programme has shown is that by having this proactive programme in place we’re able to decrease the amount of deviations from getting things done in a certain time period.

Where has the software been trialled so far, just at the Cleveland Clinic?

This software was developed at the Cleveland Clinic; it was really based on a challenge that I had to our medical physicist, Dr Yu. I asked him, is there a way that we can use software to help minimise the variation that we have in terms of getting certain tasks done. Radiation oncology involves a lot of teamwork to get things done in an efficient manner and he was able to develop a software which can help us predict when certain things may occur that are not according to plan. As a result we are able to maximise quality, minimise delays in getting patients started and hopefully maximise safety as well as part of this programme.

How long have you been using the program?

We’ve been testing this software for about four years, so four years ago I suggested a software to try to help minimise the variation in terms of how to get our treatments done. Over the past four years we’ve been working very closely with a number of individuals. So this effort, this software, is really the culmination of work from our physicians, our medical physicists, our dosimetrists, our therapists, so it’s a number of individuals who have really helped to drive this programme forward.

What improvements have occurred as a result of using the QMAP software?

If you look at the three areas that we investigated, number one was the checking of the daily CT scans, we went from about a 91% compliance to about 100% compliance with this automatic assessment tool. If you look at our weekly visits, we’ve gone from about also 91% to about 100% compliance with that. In terms of late chart arrivals we used to be at around 84% compliance and now we’re about a 94% compliance. We’ve actually made some great strides. One of the nice things about this programme is that the changes that we’ve made have actually been very sustainable as well so it’s not just a one-off, it actually has been sustainable over the past few years. Based on the success of this programme we’ve actually looked at other metrics as well that we are exploring again. And the goal of all of these assessment tools is really to maximise the efficiency of treatment, also to improve quality which hopefully will drive better patient safety.

Is the program transferrable to other practices?

What we’re hoping to do with this is that we want to continue to expand it to other areas where we feel there’s a need to actually have this type of automated tool. At some point we perhaps can have it available for other centres as well to really learn from our experiences. This is a programme that has taken four years to develop and we’ve gotten some areas done very well but we need to continue to work on it to get better results overall.

Is this something that would be relevant to practices in the US only or to all practices worldwide?

The hope and dream would be that this type of tool would be actually not only helpful in the US but also worldwide as well. Radiation oncology, as I mentioned, is very much a team effort and by getting these processes in place to make sure there’s consistency in how we do treatment, how we do treatment delivery, how we do treatment planning, will drive better patient care overall and that’s really the goal of providing best care possible.

Is this something that would be relevant to practices in the US only or to all practices worldwide?

About five years ago, one of the processes that we needed to improve at the Cleveland Clinic was how to make work flow better. One of the frustrations that I saw from some of my colleagues was that work was not getting done on time, that the work was sometimes late in terms of arrival and that caused frustration among the employees. So we wanted to develop a software that would actually enable us to more proactively determine when charts would arrive late on time, when work was not being done properly, when perhaps quality was going to be affected and this is where the QMAP product has been very successful to drive that change forward.

Is this something that you’ve installed it and it’s something that you would use every single day or every single patient? So this is something that once it’s in you use it all the time?

We use this particular software every single day so it’s something that we look at actually, in fact, 365 days a year. So in terms of the imagery review we get these messages that images have not been reviewed every single day. So it’s actually a very iterative process, something that continues throughout the entire cycle of a patient’s treatment.

Is there a single take-home message from what you have achieved with the programme so far?

With this software we’ve been able to provide a better means of providing more proactive care for the patient which should drive better quality and also drive better employee engagement as well.