W. G. Chin, B. Ghavidel, M. Washington, and O. Kayode; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
Purpose/Objective(s): Radiation therapy plays a vital role in the treatment of cancer, serving as both a primary treatment modality and an adjunctive therapy in over half of newly diagnosed cases. While the benefits of radiation therapy in cancer treatment are well-established, there are considerations regarding its interaction with cardiac implantable electronic devices (CIEDs). Estimates suggest that a significant proportion of cancer patients, including those with CIEDs, may require radiation therapy during their cancer treatment journey. However, the interaction between radiation therapy and CIEDs poses unique challenges and risks that need to be carefully addressed. The purpose of this study was to analyze the existing process for inputs and outputs within our academic institution in accordance with TG-203 guidelines. Through this examination, our goal is to deepen our comprehension of the clinical ramifications and improve the management of cancer patients with CIEDs undergoing radiation therapy. Materials/
Methods: We employed a failure mode analysis to assess the current state of care coordination workflow, spanning from the simulation order entry to the initiation of the first therapy session. A cross-functional map was collaboratively developed and reviewed within a small focus group comprising frontline staff members from various disciplines, including nurses, managers, radiation therapists, CT-sim therapists, dosimetrists/physicists, cardiologists, cardiology nurses, and administrative staff. By systematically following the workflow steps, we identified opportunities, errors, problems, and contributing factors. These findings were then categorized using a four-category decision matrix, focusing on factors impact and frequency to prioritize areas for improvement. Results: We identified 9 failure points and 8 decision points within the established process. Among the 9 failure points, 4 were classified as high impact and high frequency. These included: lack of documented CIED confirmation during consultation, discrepancies in Hospital EHR and Radiation Oncology EHR documentation of CIED, validation issues with CIED card, and lack of standardization in care-path utilization within ARIA. Conclusion: Our study highlights the complexity of managing cancer patients with CIEDs undergoing radiation therapy. Interdisciplinary collaboration is crucial to address workflow challenges and improve patient care. Implementing standardized protocols and guidelines is essential for safe and effective management. Further research and refinement are needed for continuous improvement.
