Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Cancer Res Ther. 2023 Oct 1;19(7):1975-1981. doi: 10.4103/jcrt.jcrt_39_22. Epub 2022 Aug 26.
This study aimed to report 12 years of experience in the development of a quality assurance system in radiation oncology in a university hospital.
We developed the Quality Assurance Program in Radiation Oncology (QUAPRO) in 2008 to detect treatment deviation in the radiotherapy (RT) process with three steps of near-miss detection: simulation and prescription (primary check, PC), treatment planning (secondary check, SC), and treatment delivery process (tertiary check, TC). We transferred our paper-based medical records to electronic-based radiotherapy information systems (RTISs) in 2013. QUAPRO was completely integrated into RTIS in 2017. Since then, electronic-based incident reporting has been conducted. The program is called the Radiation Incident Learning System (RILS). The near-miss rates were compared during the three time periods: 2008-2012, 2013-2017, and 2017-2020.
Five years of paper-based QUAPRO for 2008-2012 demonstrated a fluctuation in the checking ratio, with a gradually increasing rate of near misses of 3.5-19.7%. After electronic-based medical records were developed in 2013, the results revealed a dramatic increase from a rate of 2.7 to 4.2 in the number of checks per patient and achieved an increased rate of near misses of 24.7% for PC, SC, and TC. The rate of near misses gradually decreased to 5.3% after 2017 because of RT workflow improvement.
The analysis of 12 years in near-miss data reflected the effectiveness of our quality assurance program. The QUAPRO system can detect near-miss incidents in the whole RT workflow and illustrate the detection improvement when integrated into electronic-based medical records. Regular feedback and exploration of near-miss reporting are recommended for proper RT workflow improvement.
本研究旨在报告一所大学医院在放射肿瘤学质量保证体系发展方面的 12 年经验。
我们于 2008 年开发了放射肿瘤学质量保证计划（QUAPRO），通过三个接近失误检测步骤来检测放射治疗（RT）过程中的治疗偏差：模拟和处方（初级检查，PC）、治疗计划（二级检查，SC）和治疗实施过程（三级检查，TC）。我们于 2013 年将纸质病历转移到电子放射治疗信息系统（RTIS）。QUAPRO 于 2017 年完全集成到 RTIS 中。从那时起，开始进行电子事件报告。该程序称为放射事故学习系统（RILS）。在三个时间段比较接近失误率：2008-2012 年、2013-2017 年和 2017-2020 年。
2008-2012 年的 5 年纸质 QUAPRO 显示出检查比例的波动，接近失误率逐渐从 3.5-19.7%增加。2013 年开发电子病历后，结果显示每位患者的检查次数从 2.7 次增加到 4.2 次，PC、SC 和 TC 的接近失误率增加了 24.7%。2017 年后，由于 RT 工作流程的改进，接近失误率逐渐下降至 5.3%。
对近 12 年接近失误数据的分析反映了我们质量保证计划的有效性。QUAPRO 系统可以检测整个 RT 工作流程中的接近失误事件，并说明集成电子病历后的检测改进。建议定期反馈和探索接近失误报告，以适当改进 RT 工作流程。
