New Cleveland Clinic Software Boosts Process Consistency in Radiation Oncology

Process consistency is essential, but sometimes elusive in radiation oncology. It improves the quality of treatment, reduces errors and raises overall efficiency. To improve consistency in the process of planning and delivery of radiation therapy, Cleveland Clinic has designed a new software program, the Quantitative Metrics and Automatic Auditing Program, or QMAP.

The program is based on a set of quantitative metrics that rate the timely completion of critical clinical tasks, as defined internally by the Department of Radiation Oncology. QMAP generates alerts or reminders that are very effective in keeping clinicians on schedule with key tasks.

“We believe that consistency in the planning and delivery of radiation therapy is essential to maintain treatment quality, patient safety and efficiency,” says Naichang Yu, PhD, an associate staff member in the department and one of the programs’ designers. Dr. Yu is also lead author of a study of the effectiveness of QMAP, results of which were presented at the 2015 annual meeting of the American Society for Radiology Oncology (ASTRO) in San Antonio, Texas.

Alerts give clinicians time to avoid potential deviations

QMAP software automatically captures the historical trend of each metric and provides daily alerts for potential deviations (i.e., misses) from defined processes, based on Cleveland Clinic’s electronic medical record (EMR) system. Alerts are directed to triage teams within a timeframe that gives clinicians the opportunity to avoid the deviations.

The three key tasks targeted by the department and the software are:

1. Complete the radiation therapy planning process at least four hours prior to the scheduled treatment time for non-emergency patients.
2. Review patient cone-beam computed tomography (CBCT) images the same day they become available.
3. Complete visits to patients (by physicians) in a timely fashion, according to a department-defined schedule.

On average, 120 patients a day were treated by external beam radiotherapy in the department throughout the course of the study.

Study results show marked improvement in compliance

“Our internally defined goals are established above and beyond accepted industry practice standards,” Dr. Yu says. “The study demonstrated significant improvement in our compliance rate in the three metrics we studied.”

As an example, for non-emergency patients undergoing external beam radiation therapy, the planning process was completed at least four hours prior to the scheduled treatment time 96 percent of the time in December 2014, an increase from 86 percent in January 2011. “This increased compliance was well sustained throughout the period that these measures were in place,” Dr. Yu says.
In a second example, Dr. Yu notes that during the study period, the rate that physician visits were completed within the departmental-defined schedule increased from 94 percent to more than 99 percent.
The third metric studied was the timely image review rate. During the study period, the rate patient images were reviewed on the same day of acquisition increased from 91 percent to a sustained over 99 percent, says Dr. Yu.

Quantifying QMAP’s efficacy based on patient outcomes

“Timely and quality completion of every step of care preparation and delivery can improve treatment quality and patient safety. It may also improve clinical practice efficiency,” says Dr. Yu.

The abstract describing the QMAP initiative further notes that this process improvement reduces the potential for errors resulting from distractions, interruptions and hurried attempts to complete critical tasks.

In the future, Dr. Yu concludes, “Quantitative demonstration of the correlation between compliance and clinical outcomes, such as reduction of medical errors and improved clinical efficiency, will be important.”