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Investigation and Analysis of the Issue of Late Treatment Plans
Olivia Dawood, Denise Monks, Abram Recht
BIDMC Radiation Oncology
Introduction/Problem
Results/Progress to Date
OVERVIEW: The treatment planning process in Radiation Oncology begins at the end of the patient’s
simulation or planning appointment when the CT scan is sent to the planning system. The physician
works with the dosimetrist to create the optimal treatment plan for each patient. All treatment plans are
approved by the physician, dosimetrist, and a physicist before being sent to the radiation therapists.
The radiation therapist performs the final check before the patient can begin treatment.
PROBLEM: Department guideline states that all plans must arrive no later than 2 hours prior to the
start of the patient’s first treatment. Physicians are notified by the dosimetrist when the plan is ready for
review and approval. The treatment planning manager then routinely sends out 3-10 additional email
reminders a week to physicians to approve treatment plans that have been ready. Most if not all of
these plans would arrive late to the radiation therapists without email reminders. Late plans create a
high-pressure and rushed work environment for staff leading to potential errors and compromising
quality of care.
4
Aim/Goal
Reduce the number of treatment plans arriving late to the radiation therapists by 20% in 6 months
The Team
Denise Monks, RTT
Olivia Dawood, DABR
Abram Recht, MD
Ayad Hamdan, MD
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10
The Interventions
1.
2.
3.
4.
Create a treatment planning process map
Determine where in the treatment planning process workflow map the delays occur.
Survey the physicians to determine perceived barriers to approving treatment plans.
Suggest a method to improve/solve a physician barrier to reduce late arrival of plans
2
Radiation Oncology Workflow: The numbers indicate the number of times in a 4 week span the process was held
up and required an email intervention/reminder. Most obstacles involved a physician barrier.
For more information, contact:
Olivia Dawood (odawood@bidmc.harvard.edu) or Denise Monks (dmonks@bidmc.harvard.edu)
�Investigation and Analysis of the Issue of Late Treatment Plans
Olivia Dawood, Denise Monks, Abram Recht
BIDMC Radiation Oncology
More Results/Progress to Date
It was determined that the bottlenecks in the Radiation Oncology workflow were mostly due to
physician approval delays.
A survey was sent to the physician group to learn more about the physicians’ perspective and to better
understand the barriers that make is difficult to approve treatment plans in a timely manner.
91% (10 out of 11) of the Radiation Oncologists participated in the survey
PHYSICAN BARRIERS FROM SURVEY RESULTS:
No issues - 4 out of the 10 physicians answered the survey with no complaints of the current process
for physician approvals. The current system works well for them.
Remote connection difficulties/failures – 2 out of the 10 physicians described technical difficulties
in their remote connection to their desktop computer to access the software for physician approvals.
This is typically due to the physician working at other clinical sites (BID-Needham or Metrowest
Hospital).
Too busy with clinical work – 2 out of the 10 physicians stated that during the day they are typically
too busy with clinical work (patient appointments) to stop and approve the necessary work. He/She
may also not be near a computer for long periods of time for approvals.
Lack of organized worklist for physicians – 2 out of the 10 physicians stated that the lack of an
organized worklist or dashboard makes it difficult for him/her to remember their list of tasks to approve.
There currently is no method of notification or task list for physicians when it comes to plan approvals.
Each physician must refer to his/her email or image work list.
Lessons Learned
We gained more insight in understanding the barriers that the physician’s face in approving plans in a
timely manner. From the survey results, only 40% of the physicians feel content with our current
workflow system.
Technical issues, overload of clinical work, and lack of organized worklist all contribute to the delay of
physician approvals and thus creating the potential for late treatment plan arrivals.
Next Steps
Suggested next steps to reduce the number of late arrivals of treatment plans:
Work with IS team and physicians who work at remote clinical sites to improve remote connectivity
Investigate and implement a new system that can create a task list for physicians. The list of tasks
should be easily accessible and improve communication and organization for the department.
Graph 1: Results of Physician survey question regarding challenges in approvals in a timely manner
For more information, contact:
Olivia Dawood (odawood@bidmc.harvard.edu) or Denise Monks (dmonks@bidmc.harvard.edu)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Olivia Dawood (<a href="mailto:odawood@bidmc.harvard.edu">odawood@bidmc.harvard.edu</a>)<br /> Denise Monks (<a href="mailto:dmonks@bidmc.harvard.edu">dmonks@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiation Oncology
Project Team
Denise Monks
Olivia Dawood
Abram Recht
Ayad Hamdan
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Investigation and Analysis of the Issue of Late Treatment Plans
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness