Transition to Disease-Site Specific Chart Rounds: An Evaluation of Impact on Quality and Perceptions of Practitioners

ABSTRACT

Although chart rounds is an established quality assurance process, there remains minimal evidence on various forms of peer review, and some studies report relatively low error-detection rates. One question faced by both academic and community practices is whether to structure chart rounds as practice-site specific (PS) or disease-specific (DS). The global COVID pandemic may also offer new opportunities for structuring peer-review by enhancing virtual connectivity of people and practices. The purpose of this study was to determine if changes to treatment plans were recommended more often and assess perceptions following the transition to DS chart rounds. Data was prospectively collected for 6 months before and 6 months after transition to DS chart rounds at a multi-practice institution. Observed data included frequency of questions asked, educational remarks, and recommended changes to the presented plan or future patients. Time spent per case was recorded. Participants were not aware of data collection. Following 10 months of practicing DS chart rounds, a survey was distributed to faculty, dosimetrists, and trainees to assess perceptions of DS chart rounds. Two-tailed t-testing and chi-square testing were used to analyze the data. Criteria for statistical significance was p<0.05. The study was IRB-approved. Over 1 year, 1460 patients were peer reviewed;781 were reviewed by PS chart rounds and 679 by DS chart rounds. A question was asked more often in DS (49.3%) than PS (31.9%) chart rounds (p<0.001). A change to a presented plan was recommended more often in DS (4.9%) than PS (1.4%) chart rounds (p<0.001). A change was recommended for future patients more often in DS (4.4%) than PS (0.9%) chart rounds (p<0.001). An educational point was raised more often in DS (12.5%) than PS (9.3%) chart rounds (p=0.05). Time spent per case was more for DS (2.7 min) than PS (1.6 min) chart rounds (p<0.001). Overall, there were 35 survey respondents (54% response rate). Among attendings, the response rate was 74%. Of all respondents, 89% agreed DS chart rounds improve the quality of patient plans, 83% agreed DS chart rounds improve patient safety, 86% agreed DS chart rounds encourage more discussion, and 77% agreed DS chart rounds are more educational. Only 37% of respondents agreed DS chart rounds are more time efficient;however, 95% of attendings and 89% of all respondents favored continuing DS chart rounds;no respondents disagreed. Time efficiency was not associated with preference for continuing DS chart rounds (p=0.10). Favoring continuing DS chart rounds was associated with the belief that DS chart rounds improve patient safety (p<0.001), quality of patient plans (p<0.001), and education (p<0.001). DS chart rounds were associated with more discussion and recommended changes to treatment plans than PS chart rounds. Most respondents favored continuing DS chart rounds and reported that this format improved the quality of patient treatment plans and safety. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)