Duggar William N, Weatherall Lacey, Nittala Mary R, Thomas Toms V, Mundra Eswar K, Otts Jeremy, Woods William C, Yang Claus, Vijayakumar Srinivasan
Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi.
Adv Radiat Oncol. 2022 Oct 26;8(1):101117. doi: 10.1016/j.adro.2022.101117. eCollection 2023 Jan-Feb.
Total package time, or the time from diagnosis to completion of definitive treatment, has been associated with outcomes for a variety of tumor sites, but especially to head and neck (HN) cancer. Patients with HN cancer often undergo a complex diagnosis and treatment process involving multiple disciplines both within and outside of oncology. This complexity can lead to longer package times, and each involved discipline has the responsibility to maintain an efficient and effective process. Strategic intervention to improve package time must involve not only new technology or tools, but also "soft" components such as accountability, motivation, and leadership. This combination is necessary to truly optimize radiation therapy for HN cancer, leading to shorter total package times for these patients.
Two interventions were strategically executed to improve radiation therapy workflow: upgrade of the treatment planning system and implementation of an automated patient management and accountability system. The radiation therapy-related timelines of 112 patients with HN cancer treated over 2 years were reviewed, and the average time differences were compared between the patient populations before and after the strategic interventions.
Purely upgrading the treatment planning system did not show significant improvements, but when combined with the patient management system, significant improvement in radiation-related package time can be noted for every time point. The overall reduction of radiation-related package time was statistically significant at 22.85 days ( = .002).
On face value, the patient management system could be credited as responsible for the improvement, but on qualitative analysis, it is noted that the new system is only a tool that can be ignored or underused. Owing to the addition of important "soft" components such as accountability, motivation, and leadership, the patient management system was optimized and implemented in such a manner as to have the desired effect.
总治疗时间，即从诊断到完成确定性治疗的时间，已与多种肿瘤部位的治疗结果相关，尤其是头颈部（HN）癌。HN癌患者通常要经历一个复杂的诊断和治疗过程，涉及肿瘤学内外的多个学科。这种复杂性可能导致更长的总治疗时间，而每个相关学科都有责任维持高效且有效的流程。改善总治疗时间的战略干预不仅必须涉及新技术或工具，还必须包括诸如问责制、积极性和领导力等“软”要素。这种组合对于真正优化HN癌的放射治疗是必要的，从而为这些患者缩短总治疗时间。
为改善放射治疗工作流程，战略性地实施了两项干预措施：治疗计划系统的升级以及自动化患者管理和问责系统的实施。回顾了2年内接受治疗的112例HN癌患者与放射治疗相关的时间线，并比较了战略干预前后患者群体之间的平均时间差异。
单纯升级治疗计划系统并未显示出显著改善，但与患者管理系统相结合时，每个时间点的放射治疗相关总治疗时间均有显著改善。放射治疗相关总治疗时间的总体减少在统计学上具有显著意义，为22.85天（P = 0.002）。
从表面上看，患者管理系统可被认为是改善的原因，但经定性分析发现，新系统只是一个可能被忽视或未充分利用的工具。由于增加了问责制、积极性和领导力等重要的“软”要素，患者管理系统得以优化并以产生预期效果的方式实施。
