Making Patient Safety a Priority: Standardizing Workflow From CT Simulation to Radiation Therapy Start to Allow Adequate Time for Safety Checks

Improving radiotherapy safety and efficiency with the customized ARIA oncology information system

OBJECTIVE

To improve safety and efficiency of radiotherapy process by customizing a Varian ARIA oncology information system following the guidelines provided in AAPM TG-100 report.

METHODS

First, failure mode and effects analysis (FMEA) and quality management program were implemented for radiotherapy process. We have customized the visual care path in the ARIA system and set up a series of templates for simulation, prescription, contouring, treatment planning, and multiple checklists. Average time of activities' completion and amount of planning errors were compared before and after the use of the customized ARIA to evaluate its impact on the efficiency and safety of radiotherapy.

RESULTS

Completion time and on-time completion rate of the key activities in the care path are improved. The time of OAR/targets contouring decreases from (1.94±1.51) days to (1.64±1.07) days (p = 0.003), with the on-time completion rate increases from 77.4%to 83.3%(p = 0.048). Treatment planning time decreases from (0.81±0.65) days to (0.55±0.51) days (p < 0.001), with the on-time completion rate increases from 96.6%to 98.3%(p = 0.163). Waiting time of patients decreases from (4.50±1.83) days to (4.04±1.34) days (p < 0.001), with the on-time completion rate increases from 81.9%to 89.7%(p = 0.003). In addition, the average plan error rate decreases from 5.5%(2.9%for safety errors and 2.6%for non-normative errors) to 2.4%(1.6%for safety errors and 0.8%for non-normative errors) (p = 0.029).

CONCLUSION

Our study demonstrates that the customized ARIA system has the potential to promote efficiency and safety in radiotherapy process management. It is beneficial to organize and accelerate the treatment process with more effective communications and fewer errors.