Vijayakumar Srinivasan, Duggar William Neil, Packianathan Satya, Morris Bart, Yang Chunli Claus
Radiation Oncology Department, University of MS Medical Center, Jackson, MS, United States.
Front Oncol. 2019 Apr 24;9:302. doi: 10.3389/fonc.2019.00302. eCollection 2019.
The Joint Commission has encouraged the healthcare industry to become "High Reliability Organizations" by "Chasing Zero Harm" in patient care. In radiation oncology, the time point of quality checks determines whether errors are prevented or only mitigated. Thus, to "chase zero" in radiation oncology, peer review has to be implemented prior to treatment initiation. A multidisciplinary group consensus peer review (GCPR) model is used pre-treatment at our institution and has been successful in our efforts to "chase zero harm" in patient care. With the GCPR model, policy-defined complex cases go through a treatment planning conference, which includes physicians, residents, physicists, and dosimetrists. Three major plan aspects are reviewed: target volumes, target and normal tissue dose coverage, and dose distributions. During the review, any team member can ask questions and afterwards a group consensus is taken regarding plan approval. The GCPR model has been implemented through a commitment to peer review and creative conference scheduling. Automated analysis software is used to depict color-coded results for department approved target coverage and dose constraints. About 8% of plans required re-planning while about 23% required minor changes. The mean time for review of each plan was 8 min. Catching errors prior to treatment is the only way to "chase zero" in radiation oncology. Various types of errors may exist in treatment plans and our GCPR model succeeds in preventing many errors of all shapes and sizes in target definition, dose prescriptions, and treatment plans from ever reaching the patients.
联合委员会鼓励医疗行业通过在患者护理中“追求零伤害”，成为“高可靠性组织”。在放射肿瘤学中，质量检查的时间点决定了是预防还是仅减轻错误。因此，为了在放射肿瘤学中“追求零伤害”，必须在治疗开始前进行同行评审。我们机构在治疗前采用了多学科小组共识同行评审（GCPR）模型，并且在我们“追求患者护理零伤害”的努力中取得了成功。采用GCPR模型时，政策定义的复杂病例要经过一个治疗计划会议，参会人员包括医生、住院医师、物理学家和剂量师。对计划的三个主要方面进行评审：靶区体积、靶区和正常组织的剂量覆盖以及剂量分布。在评审过程中，任何团队成员都可以提问，之后就计划批准达成小组共识。GCPR模型是通过对同行评审的承诺和创造性的会议安排来实施的。使用自动化分析软件来描绘部门批准的靶区覆盖和剂量限制的彩色编码结果。约8%的计划需要重新规划，约23%的计划需要进行小的修改。每个计划的平均评审时间为8分钟。在治疗前发现错误是放射肿瘤学中“追求零伤害”的唯一途径。治疗计划中可能存在各种类型的错误，而我们的GCPR模型成功地防止了许多在靶区定义、剂量处方和治疗计划中各种大小和形状的错误影响到患者。
