An automated electronic system for radiation treatment plan peer review reduces missed reviews at a large, high-volume academic center

Publication date: Available online 16 March 2016
Source:Practical Radiation Oncology
Author(s): Peter E. Gabriel, Kristina D. Woodhouse, Alexander Lin, Jarod C. Finlay, Richard B. Young, Edna Volz, Stephen M. Hahn, James M. Metz, Amit Maity
BackgroundAssuring quality in cancer care through peer review has become increasingly important in radiation oncology. In 2012, the Department of Radiation Oncology at XX implemented an automated electronic system for radiation treatment plan peer review. The purpose of this study was to compare the overall impact of this electronic system to our previous manual, paper-based system.MethodsIn an effort to improve management, an automated electronic system for case finding and documentation of review was developed and implemented. The rates of missed initial reviews, late reviews, and missed re-reviews were compared for the pre- vs. post-electronic system cohorts using Pearson's chi-squared test and relative risk. Major and minor changes or recommendations were documented and shared with the assigned clinical provider.ResultsThe overall rate of missed reviews was 7.6% (38/500) prior to system implementation vs. 0.4% (28/6985) under the electronic system (p<0.001). In terms of relative risk, courses were 19.0 times (95% CI 11.8-30.7) more likely to be missed for initial review prior to the automated system. Missed re-reviews occurred in 23.1% (3/13) of courses in the pre-electronic system cohort and 6.6% (10/152) of courses in the post-electronic system cohort (p = 0.034). Late reviews were more frequent during high travel or major holiday periods. Major changes were recommended in 2.2% and 2.8% in the pre- vs. post-electronic systems, respectively. Minor changes were recommended in 5.3% of all post-electronic cases.ConclusionThe implementation of an automated electronic system for managing peer review in a large, complex department was effective in significantly reducing the number of missed reviews and missed re-reviews when compared to our previous manual system.



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