Schubert Leah, Liu Arthur, Gan Gregory, Amini Arya, Hutchison Rebecca, Ernest Janyce, Thornton Dale, Stoehr Scott, Hinman Bonnie, Stuhr Kelly, Westerly David, Schefter Tracey, Fisher Christine
Department of Radiation Oncology, University of Colorado, Aurora, Colorado.
Department of Radiation Oncology, University of Colorado, Aurora, Colorado.
Pract Radiat Oncol. 2016 Jan-Feb;6(1):34-43. doi: 10.1016/j.prro.2015.09.003. Epub 2015 Sep 18.
High-dose-rate (HDR) brachytherapy is a high-risk procedure with serious errors reported in the medical literature. Our goal was to develop a quality improvement framework for HDR brachytherapy using a multidisciplinary approach. This work describes the time, personnel, and materials involved in implementation as well as staff-reported safety benefits of quality improvement checklists.
Quality improvement was achieved using a department-wide multidisciplinary approach. Process mapping of the entire HDR program, from initial scheduling through follow-up, was performed. The scope of the project was narrowed to the point of treatment delivery. Two types of multidisciplinary checklists were created: a safety-timeout checklist to ensure safety-critical actions were performed before treatment initiation; and detailed procedure checklists that served as written procedures for physicians, physicists, dosimetrists, and nurses. Implementation was carried out through initial training led by various staff members, creation of visual training guides, piloting and use of checklists for all treatments, and auditing of checklist compliance.
Process maps of the entire HDR program were generated and used to guide subsequent changes in the treatment delivery process. A single safety-timeout checklist and the individual procedure checklists were created and used at the time of treatment delivery. The 3-month audit showed that the safety-timeout checklist was used for 100% of treatment fractions. Individual procedure checklists were used for 85% of fractions. All cross-covering physicians and physicists continued to use these checklists 100% of the time. Staff survey results indicated improvements in safety and increased benefits for cross-covering staff.
In using a multidisciplinary approach to quality improvement, process mapping and comprehensive checklists for HDR treatment delivery have been implemented. This has resulted in improved practices that are optimal in our department. This experience can provide others with practical strategies toward implementing such changes in their own facilities.
高剂量率（HDR）近距离放射治疗是一项高风险程序，医学文献中报道了一些严重错误。我们的目标是采用多学科方法为HDR近距离放射治疗制定一个质量改进框架。这项工作描述了实施过程中涉及的时间、人员和材料，以及工作人员报告的质量改进检查表的安全效益。
采用全科室多学科方法实现质量改进。对整个HDR程序进行了流程映射，从初始排班到随访。项目范围缩小到治疗实施点。创建了两种多学科检查表：一种安全暂停检查表，以确保在治疗开始前执行关键安全操作；以及详细的程序检查表，作为医生、物理学家、剂量师和护士的书面程序。通过由不同工作人员进行的初始培训、创建视觉培训指南、对所有治疗使用检查表进行试点和使用，以及对检查表合规情况进行审核来实施。
生成了整个HDR程序的流程图，并用于指导治疗实施过程中的后续变更。在治疗实施时创建并使用了一份单一的安全暂停检查表和各程序检查表。3个月的审核显示，安全暂停检查表在100%的治疗分次中得到使用。各程序检查表在85%的分次中得到使用。所有交叉值班的医生和物理学家继续100%地使用这些检查表。工作人员调查结果表明安全性有所提高，交叉值班人员的效益增加。
在采用多学科方法进行质量改进时，已实施了HDR治疗实施的流程映射和综合检查表。这带来了改进的做法，在我们科室是最佳的。这一经验可为其他人在自己的机构实施此类变更提供实用策略。
