Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York.
Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York.
Pract Radiat Oncol. 2012 Jan-Mar;2(1):18-26. doi: 10.1016/j.prro.2011.04.010. Epub 2011 Jun 16.
The safe delivery of radiation therapy requires multiple disciplines and interactions to perform flawlessly for each patient. Because treatment is individualized and every aspect of the patient's care is unique, it is difficult to regiment a delivery process that works flawlessly. The purpose of this study is to describe one safety-directed component of our quality program called the "No Fly Policy" (NFP).
Our quality assurance program for radiation therapy reviewed the entire process of care prior, during, and after a patient's treatment course. Each component of care was broken down and rebuilt within a matrix of multidisciplinary safety quality checklists (QCL). The QCL process map was subsequently streamlined with revised task due dates and stopping rules. The NFP was introduced to place a holding pattern on treatment initiation pending reconciliation of associated stopping events. The NFP was introduced in a pilot phase using a Six-Sigma process improvement approach. Quantitative analysis on the performance of the new QCLs was performed using crystal reports in the Oncology Information Systems. Root cause analysis was conducted.
Notable improvements in QCL performance were observed. The variances among staff in completing tasks reduced by a factor of at least 3, suggesting better process control. Steady improvements over time indicated an increasingly compliant and controlled adoption of the new safety-oriented process map. Stopping events led to rescheduling treatments with average and maximum delays of 2 and 4 days, respectively, with no reported adverse effects. The majority of stopping events were due to incomplete plan approvals stemming from treatment planning delays. Whereas these may have previously solicited last-minute interventions, including intensity modulated radiation therapy quality assurance, the NFP enabled nonpunitive, reasonable schedule adjustments to mitigate compromises in safe delivery.
Implementation of the NFP has helped to mitigate risk from expedited care, convert reactive to proactive delays, and created a checklist, process driven, and variance-reducing culture in a large, multicenter department.
放射治疗的安全实施需要多个学科和交互作用，以确保每个患者的治疗都能完美无缺。由于治疗是个体化的，患者护理的每个方面都是独特的，因此很难制定出完美无缺的交付流程。本研究的目的是描述我们质量计划中的一个安全导向组件，称为“禁飞政策”（NFP）。
我们的放射治疗质量保证计划审查了患者治疗过程前后的整个护理过程。护理的每个组成部分都在多学科安全质量检查表（QCL）的矩阵中进行了分解和重建。随后，通过修订任务的截止日期和停止规则，简化了 QCL 流程图。引入 NFP 是为了在治疗开始时暂停治疗，等待相关停止事件的协调。NFP 是在试点阶段引入的，采用六西格玛过程改进方法。使用 Oncology Information Systems 中的 Crystal Reports 对新 QCL 的性能进行了定量分析。进行了根本原因分析。
观察到 QCL 性能的显著改进。员工完成任务的差异减少了至少 3 倍，表明过程控制得到了改善。随着时间的推移稳步改进表明，新的以安全为导向的流程图的采用越来越符合规定和受到控制。停止事件导致治疗重新安排，平均和最大延迟分别为 2 天和 4 天，没有报告不良影响。大多数停止事件是由于治疗计划延迟导致计划批准不完整。虽然这些事件以前可能需要进行最后一刻的干预，包括调强放射治疗质量保证，但 NFP 使非惩罚性、合理的日程调整成为可能，以减轻安全交付中的妥协。
实施 NFP 有助于减轻加速护理的风险，将反应性延迟转化为主动性延迟，并在一个大型的多中心部门中创建了一个检查表、流程驱动、减少差异的文化。
