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Title: Quality Assurance Peer Review Chart Rounds in 2011: A Survey of Academic Institutions in the United States

Abstract

Purpose: In light of concerns regarding the quality of radiation treatment delivery, we surveyed the practice of quality assurance peer review chart rounds at American academic institutions. Methods and Materials: An anonymous web-based survey was sent to the chief resident of each institution across the United States. Results: The response rate was 80% (57/71). The median amount of time spent per patient was 2.7 minutes (range, 0.6-14.4). The mean attendance by senior physicians and residents was 73% and 93%, respectively. A physicist was consistently present at peer review rounds in 66% of departments. There was a close association between attendance by senior physicians and departmental organization: in departments with protected time policies, good attendance was 81% vs. 31% without protected time (p = 0.001), and in departments that documented attendance, attending presence was 69% vs. 29% in departments without documentation (p < 0.05). More than 80% of institutions peer review all external beam therapy courses; however, rates were much lower for other modalities (radiosurgery 58%, brachytherapy 40%-47%). Patient history, chart documentation, and dose prescription were always peer reviewed in >75% of institutions, whereas dosimetric details (beams, wedges), isodose coverage, intensity-modulated radiation therapy constraints, and dose-volume histograms were always peer reviewedmore » in 63%, 59%, 42%, and 50% of cases, respectively. Chart rounds led to both minor (defined as a small multileaf collimator change/repeated port film) and major (change to dose prescription or replan with dosimetry) treatment changes. Whereas at the majority of institutions changes were rare (<10% of cases), 39% and 11% of institutions reported that minor and major changes, respectively, were made to more than 10% of cases. Conclusion: The implementation of peer review chart rounds seems inconsistent across American academic institutions. Brachytherapy and radiosurgical procedures are rarely reviewed. Attendance by senior physicians is variable, but it improves when scheduling clashes are avoided. The potential effect of a more thorough quality assurance peer review on patient outcomes is not known.« less

Authors:
 [1];  [2];  [2];  [1];  [3];  [4];  [2];  [1];  [3]; ; ;  [1]
  1. Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States)
  2. (Israel)
  3. (United States)
  4. Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer (Israel)
Publication Date:
OSTI Identifier:
22149551
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRACHYTHERAPY; DOSIMETRY; FILMS; IMPLEMENTATION; PATIENTS; QUALITY ASSURANCE; RADIATION DOSES; SURGERY

Citation Formats

Lawrence, Yaacov Richard, E-mail: yaacovla@gmail.com, Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, Sackler School of Medicine, Tel Aviv University, Whiton, Michal A., Department of Radiation Oncology, Skagit Valley Hospital Regional Cancer Care Center, Mt. Vernon, Washington, Symon, Zvi, Sackler School of Medicine, Tel Aviv University, Wuthrick, Evan J., Department of Radiation Oncology, Ohio State University, Columbus, Ohio, Doyle, Laura, Harrison, Amy S., and Dicker, Adam P. Quality Assurance Peer Review Chart Rounds in 2011: A Survey of Academic Institutions in the United States. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.029.
Lawrence, Yaacov Richard, E-mail: yaacovla@gmail.com, Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, Sackler School of Medicine, Tel Aviv University, Whiton, Michal A., Department of Radiation Oncology, Skagit Valley Hospital Regional Cancer Care Center, Mt. Vernon, Washington, Symon, Zvi, Sackler School of Medicine, Tel Aviv University, Wuthrick, Evan J., Department of Radiation Oncology, Ohio State University, Columbus, Ohio, Doyle, Laura, Harrison, Amy S., & Dicker, Adam P. Quality Assurance Peer Review Chart Rounds in 2011: A Survey of Academic Institutions in the United States. United States. doi:10.1016/J.IJROBP.2012.01.029.
Lawrence, Yaacov Richard, E-mail: yaacovla@gmail.com, Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, Sackler School of Medicine, Tel Aviv University, Whiton, Michal A., Department of Radiation Oncology, Skagit Valley Hospital Regional Cancer Care Center, Mt. Vernon, Washington, Symon, Zvi, Sackler School of Medicine, Tel Aviv University, Wuthrick, Evan J., Department of Radiation Oncology, Ohio State University, Columbus, Ohio, Doyle, Laura, Harrison, Amy S., and Dicker, Adam P. Thu . "Quality Assurance Peer Review Chart Rounds in 2011: A Survey of Academic Institutions in the United States". United States. doi:10.1016/J.IJROBP.2012.01.029.
@article{osti_22149551,
title = {Quality Assurance Peer Review Chart Rounds in 2011: A Survey of Academic Institutions in the United States},
author = {Lawrence, Yaacov Richard, E-mail: yaacovla@gmail.com and Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer and Sackler School of Medicine, Tel Aviv University and Whiton, Michal A. and Department of Radiation Oncology, Skagit Valley Hospital Regional Cancer Care Center, Mt. Vernon, Washington and Symon, Zvi and Sackler School of Medicine, Tel Aviv University and Wuthrick, Evan J. and Department of Radiation Oncology, Ohio State University, Columbus, Ohio and Doyle, Laura and Harrison, Amy S. and Dicker, Adam P.},
abstractNote = {Purpose: In light of concerns regarding the quality of radiation treatment delivery, we surveyed the practice of quality assurance peer review chart rounds at American academic institutions. Methods and Materials: An anonymous web-based survey was sent to the chief resident of each institution across the United States. Results: The response rate was 80% (57/71). The median amount of time spent per patient was 2.7 minutes (range, 0.6-14.4). The mean attendance by senior physicians and residents was 73% and 93%, respectively. A physicist was consistently present at peer review rounds in 66% of departments. There was a close association between attendance by senior physicians and departmental organization: in departments with protected time policies, good attendance was 81% vs. 31% without protected time (p = 0.001), and in departments that documented attendance, attending presence was 69% vs. 29% in departments without documentation (p < 0.05). More than 80% of institutions peer review all external beam therapy courses; however, rates were much lower for other modalities (radiosurgery 58%, brachytherapy 40%-47%). Patient history, chart documentation, and dose prescription were always peer reviewed in >75% of institutions, whereas dosimetric details (beams, wedges), isodose coverage, intensity-modulated radiation therapy constraints, and dose-volume histograms were always peer reviewed in 63%, 59%, 42%, and 50% of cases, respectively. Chart rounds led to both minor (defined as a small multileaf collimator change/repeated port film) and major (change to dose prescription or replan with dosimetry) treatment changes. Whereas at the majority of institutions changes were rare (<10% of cases), 39% and 11% of institutions reported that minor and major changes, respectively, were made to more than 10% of cases. Conclusion: The implementation of peer review chart rounds seems inconsistent across American academic institutions. Brachytherapy and radiosurgical procedures are rarely reviewed. Attendance by senior physicians is variable, but it improves when scheduling clashes are avoided. The potential effect of a more thorough quality assurance peer review on patient outcomes is not known.},
doi = {10.1016/J.IJROBP.2012.01.029},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}