3155 - Evaluation of Clinical and Educational Impact of Head and Neck-Specific Chart Rounds in a High-Volume Multi-Center Integrated Health Care System

F. Dayani¹, M. Zhi², Z. A. Husain³, B. Khodayari⁴, A. Bardwell⁵, J. Han⁶, W. W. Lien², J. Chen², S. Iganej², and O. Bhattasali²; ¹Kaiser Permanente Los Angeles Medical Center Residency Program, Los Angeles, CA, ²Southern California Permanente Medical Group, Los Angeles, CA, ³Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada, ⁴Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, ⁵Kaiser Permanente Southern California Medical Group, Los Angeles, CA, ⁶Southern California Permanente Medical Group, Anaheim, CA

Purpose/Objective(s): Peer review of radiation treatment (RT) plans in chart rounds is an integral part of radiation oncology clinical practice, ensuring optimization of treatment plans with respect to patient safety and disease control outcomes. Our institution previously conducted general chart rounds for all disease subsites. In September 2023, we implemented a bi-monthly, head and neck (HN)-specific chart rounds for attending physicians sub-specialized in HN radiation oncology. This study evaluates the clinical and educational impact of HN chart rounds on residents and attending physicians at our institution. Materials/

Methods: An electronic, anonymous survey was distributed between February 2024 and March 2024 amongst residents (N=8), and HN attending physicians (N=14) at four radiation therapy centers within an integrated health care system. The survey was comprised of multiple choice, 5-point Likert scale, and open response questions focusing on the clinical and educational quality, perceived benefits and challenges of implementation, and the resulting impact on trainee and attending physician clinical practice.
Results: Participant response rate was 73%. Responding attending physicians had been in practice for 1-3 years (33%), 4-9 years (33%), or >10 years (33%). Eighty-eight percent of participants were moderately or extremely satisfied with the overall clinical quality of HN chart rounds, and 81% of participants were moderately or extremely satisfied with the educational quality of HN chart rounds. Target volume delineation discussion (100%), practice pattern observation across different centers (88%), and direct feedback on RT plans (69%) were reported as the most educational. Attending physicians also reported perceived educational benefit from having dedicated time to focus on more complex RT plans (78%) and assessing resident knowledge (78%). Fifty-six percent of participants reported making changes in their clinical practice, and 81% reported improvement in quality control and patient safety since implementation of HN chart rounds. Peer review resulted in minor plan adjustments for 69% of physicians and plan of care changes (i.e. requiring additional imaging, biopsy, or tumor board discussion) for 6% of physicians. No major plan adjustments were reported. Eighty-one percent of participants advocated for increased time and frequency of HN chart rounds for more in-depth discussion, and 31% requested plan review to be scheduled prior to the start of radiation treatment to accommodate potential major changes in treatment plan without treatment interruptions.
Conclusion: Implementation of HN-specific chart rounds in a high-volume multi-center institution was perceived by physicians to improve quality assurance and patient safety. Resident and attending physician education was felt to be enhanced through exchange of clinical knowledge and practice variation.