K. Martin1, G. Thornton1, P. Beickman1, P. S. Otageri1, A. Yaney1, A. Buerkel2, and M. S. Rajagopalan1,3; 1Mount Carmel Health System, Grove City, OH, 2Mount Carmel Health System, Columbus, OH, 3Radiology, Inc., Columbus, OH
Purpose/Objective(s): Physician peer review is an integral component of patient quality and safety in radiation oncology. Prospective peer review (PPR), when conducted before the patient begins radiation treatment, is superior to retrospective peer review (RPR) as there is greater opportunity to address potential issues and make modifications if necessary. However, there are many barriers to PPR including efficient identification of patients, time commitment, documentation, and lack of peers especially in smaller, community-based settings. We describe our efforts to improve peer review leveraging a patient tracking whiteboard in a community-based health system. Materials/
Methods: This study was conducted at a community-based health system with each facility having 1-2 radiation oncologists. In 2021, we implemented a patient tracking whiteboard using widely available collaboration software at one facility to improve efficiency and communication. In 2024, we implemented the whiteboard at a second facility. The whiteboard was further customized to track which patients were ready for peer review. The peer review was performed during a newly implemented weekly, virtual combined chart rounds between both sites. We compared the PPR rate in Jan-Feb 2024 (after implementation of these new processes) to the same period one year prior. Results: We identified all new patients at both facilities undergoing peer review for all treatment modalities in Jan-Feb 2023 (n=103) and Jan-Feb 2024 (n=131). The distribution of treatment modality was 49.1% 3D CRT, 33.3% IMRT/VMAT, and 12.4% SBRT. After implementation of the patient tracking whiteboard for peer review, the percent with PPR increased substantially from 22.3% in 2023 to 71.0% in 2024 (p<0.0001). There was no statistical difference in the mean working days between simulation and start between the years (6.8 vs. 7.0 days, p=0.62). Conclusion: We found that utilization of a patient tracking whiteboard could efficiently identify patients for peer review and substantially improved the percent of patients undergoing prospective peer review from 22.3% to 71.0% in a community-based health system. We found this implementation to be simple, cost-effective, efficient, and successful without requiring additional time from physician or staff schedules. This approach could serve as one model for quality improvement in other community-based programs.
