A comprehensive quality assurance program for personnel and procedures in radiation oncology: value of voluntary error reporting and checklists.

PURPOSE: This report describes the value of a voluntary error reporting system and the impact of a series of quality assurance (QA) measures including checklists and timeouts on reported error rates in patients receiving radiation therapy. METHODS AND MATERIALS: A voluntary error reporting system was instituted with the goal of recording errors, analyzing their clinical impact, and guiding the implementation of targeted QA measures. In response to errors committed in relation to treatment of the wrong patient, wrong treatment site, and wrong dose, a novel initiative involving the use of checklists and timeouts for all staff was implemented. The impact of these and other QA initiatives was analyzed. RESULTS: From 2001 to 2011, a total of 256 errors in 139 patients after 284,810 external radiation treatments (0.09% per treatment) were recorded in our voluntary error database. The incidence of errors related to patient/tumor site, treatment planning/data transfer, and patient setup/treatment delivery was 9%, 40.2%, and 50.8%, respectively. The compliance rate for the checklists and timeouts initiative was 97% (P<.001). These and other QA measures resulted in a significant reduction in many categories of errors. The introduction of checklists and timeouts has been successful in eliminating errors related to wrong patient, wrong site, and wrong dose. CONCLUSIONS: A comprehensive QA program that regularly monitors staff compliance together with a robust voluntary error reporting system can reduce or eliminate errors that could result in serious patient injury. We recommend the adoption of these relatively simple QA initiatives including the use of checklists and timeouts for all staff to improve the safety of patients undergoing radiation therapy in the modern era.

Radical systems change. Innovative strategies to improve patient satisfaction.

A project was initiated at Northwestern Memorial Hospital in Chicago focusing on patient satisfaction in the outpatient setting and how to improve it. Eight outpatient diagnostic areas were selected and a steering committee was formed. The team used patient satisfaction scores and patient and staff interviews to identify areas for improvement. Innovations were implemented in communications and information technology, staff role design, and process flow. Successes were realized in patient satisfaction above the 95th percentile, improved staff satisfaction, productivity, and internal and external recognition. The program serves as an organizationwide model supporting the hospital's Best Patient Experience strategic goal. This patient-focused model is being replicated in other areas of the hospital and can be replicated elsewhere.