By Matt Spraker, MD, PhD, @SprakerMDPhD
Patient Safety Awareness Week, an annual celebration of patient safety and quality improvement initiatives, took place this year on March 8-14. Even in the midst of the COVID-19 global outbreak, radiation oncology professionals took to social media (#PSAW20) to highlight their dedication to delivering safe and high-quality radiation therapy to their patients. Some took a more traditional approach and highlighted their important contributions to patient safety. Dr. Tom Boike (@TomBoike) shared that he was out on an APEx accreditation survey, and Dr. Louis Potters (@DrPotters) showed a new chapter of Dr. Leonard Gunderson’s textbook focused on patient safety and quality improvement. Others decided to push the envelope with the latest trends. Quality and safety expert radiation oncologist Dr. Sue Evans (@SueEvansMDMPH) shared our field’s first TikTok video that showcases Yale’s patient safety efforts while rocking out to the internet’s most famous safety song “I Wanna be Safe” by Derek Wilson.
One of the most discussed topics was RO-ILS: Radiation Oncology Incident Learning System®. This multi-center database stores data about unsafe conditions and patient safety incidents in radiation oncology with a patient safety organization to facilitate shared learning and quality improvement in a secure, non-punitive environment. The program has been sponsored by ASTRO and the AAPM as well as supported by numerous industry partners and sister societies. During #PSAW20, ASTRO (@ASTRO_org) shared RO-ILS in Review, which documents the first five years of experience of the program. RO-ILS has over 500 enrolled facilities from almost every state and has collected reports on over 12,000 safety events and the program continues to grow. Oregon Health & Science University (@OHSURadMed) shared that they were implementing RO-ILS just in time for the #PSAW20 celebration! ASTRO also released an APEx in Review report, highlighting the reduction made to the accreditation timeline as a result of programmatic improvements and evidence indicators with low compliance — areas for improvement by our community!
Many #PSAW20 posts highlighted specific strategies that departments have used to improve patient safety. Dr. Evans highlighted a RO-ILS program document on implementing a “Great Catch Program,” which can be used to improve departmental safety culture and support incident reporting. Dr. Eric Ford (@EricFor85220573) shared the “Great Catch” pin, which is awarded to professionals in the Great Catch Program at the University of Washington. Dr. Ann Raldow (@AnnRaldow_MD) shared a video about a collaboration between UCLA, UCSF (@UCSFCancer), and the Richmond VA that uses computer automation to reduce the risk of therapeutic radiation incidents. She also shared another #UCLARadOnc video that discusses 100% prospective peer review for SRS and SBRT treatments. Dr. Elizabeth Covington (@elizapowerpuff) shared two videos on her work with colleagues at University of Alabama regarding a script to reduce shift errors and an open source solution for complying with TG-263 structured naming.
Toward the end of the week, the #PSAW20 discussions urgently shifted focus toward keeping patients and radiation oncology professionals safe during the COVID19 pandemic. On March 14-15, Radiation Nation (@Rad_Nation), led by Drs. Matthew Katz (@subatomicdoc) and Richard Simcock (@BreastDocUK), hosted an urgent radiation oncology journal club on Twitter which drew 121 contributors from around the globe. The discussion focused on four key domains (listed below) and was summarized in a blog post by Dr. Simcock and led to rapid publication of a paper.
Four key domains of the journal club discussion:
- How do we deliver treatments with reduced workforce?
- Are there ways of working remotely that can still utilize an isolated workforce?
- Do we move to more simple plans and/or hypofractionate?
- What barriers exist to making these changes urgently?
- What risks to our patients can we mitigate?
- Should we change/stop/delay certain treatments?
- How do we treat a confirmed #COVID case with #radonc?
The international community of radiation oncologists have demonstrated their exceptional commitment to patient safety with their response to the COVID-19 pandemic. Drs. Ramesh Rengan and Ford and their team published a webinar and an editorial with recommendations for clinical management based on early experiences in Seattle. Authors from Italy, Switzerland and China (Wuhan), among others, have shared their lessons learned on how best to keep our patients and ourselves safe in these unprecedented times. Links to these articles and more have been cataloged and shared by ASTRO. ASTRO also released FAQs, clinical and coding guidance and is actively advocating on behalf of the community. As new information emerges, ASTRO continues to collate and develop resources to support our field.
While #PSAW20 occurred in the midst of significant challenges facing our field, radiation oncologists have delivered an inspiring response to help each other keep everybody safe. When clinical operations return to normal, I hope that we can apply all we have learned to continue to optimize patient safety and quality improvement for all of our patients across the world.
By Ksenija Kujundzic, Quality Improvement Manager
This year, Patient Safety Awareness Week (PSAW), sponsored by the Institute for Healthcare Improvement, will take place March 8-14. The week offers the opportunity to celebrate the numerous quality and safety initiatives already in place and to identify what more can be done to improve patient safety.
On any given day within a radiation oncology practice, radiation oncology professionals commit themselves to delivering safe and high-quality treatment. In this team effort, everyone plays a critical role. For example, radiation therapists perform time-outs, dosimetrists develop safe treatment plans, medical physicists conduct quality assurance tests on machines, radiation oncologists discuss patient cases during peer review meetings, and the entire team develops standard processes and promotes a positive safety culture. Radiation oncology professionals commit themselves to safety every day, and PSAW is a great time to celebrate this commitment.
There are a number of ways you can join ASTRO in promoting safety during PSAW:
Share your practices’ safety initiatives. ASTRO invites clinicians and practices to share on social media how you are a #SafetyChampion by describing a local initiative implemented to promote patient safety. Post a brief video (one to two minutes) or short statement (two to three sentences) on social media using the hashtags #SafetyChampion and #PSAW20 and tag @ASTRO_org. For details, such as tips on creating a video, read more about the #SafetyChampion initiative.
Pursue accreditation. Any practice that starts an application for Accreditation Program for Excellence (APEx®) by March 31, 2020, will receive $1,500 off the total application price. This discount is valid for new practices and those practices seeking reaccreditation. The application process includes providing practice information (e.g., annual number of new patients treated, treatments offered, equipment and physician names), signing agreements and submitting payment.
APEx evaluates all aspects of a radiation oncology practice to further promote consistent patient-centered care. Facilities accredited by APEx are recognized as having demonstrated a commitment to providing safe, high-quality care to patients and elevating the culture of safety.
Contact ASTRO staff to learn more about the program and available discount.
Join RO-ILS and/or report safety events. RO-ILS: Radiation Oncology Incident Learning System® is one of the few specialty-specific programs that collects safety data via a federally listed patient safety organization, with more than 500 facilities across the U.S. already enrolled. Join for free today!
Already enrolled in RO-ILS?
- Highlight to staff the importance of reporting all safety events, including incidents, near misses, and more into RO-ILS.
- Analyze your practice’s data utilizing the Analysis Wizard within the RO-ILS portal.
- Celebrate safety interventions implemented in the past year.
- Thank and praise staff for submitting events, going above and beyond and for catching an incident before it reached the patient.
Read the RO-ILS and APEx program reports. RO-ILS and APEx 2019 reports will be released during PSAW on the ASTRO website. As key components of ASTRO's patient safety initiative, Target Safely, RO-ILS and APEx demonstrates the Society’s and the field’s commitment to improving quality and safety. The RO-ILS report will highlight advancements in incident learning, such as an automated prioritization and triage mechanism. The APEx report will discuss low performing evidence indicators that practices should strive to improve.
Engage with the radiation oncology and health care community. Join the conversation about patient safety on discussion threads in ASTRO’s online community, ROhub. Ask safety-related questions of your fellow radiation oncology clinicians.
Engage with the larger house of medicine on social media and help us raise the profile of radiation oncology. For example, share interesting articles related to patient safety. Celebrate your team’s efforts toward improving quality by posting a photo of you and your team with a PSAW sign (see example, right, from last year). With all related 2020 social media posts, be sure to include the hashtags #PSAW20 and #ROSafety and tag @ASTRO_org.
Discuss safety with patients.Some patients worry about the safety of radiation therapy. Radiation has been used successfully to treat patients for more than 100 years. In that time, many advances have been made to ensure that radiation therapy is safe and effective. Share ASTRO’s RTAnswers resources with patients, which include disease site-specific resources and a video and handout with questions for patients to ask their doctor about radiation safety.
Review scientific literature on patient safety. One of the key focus areas of Practical Radiation Oncology (PRO), ASTRO’s official clinical practice journal, is patient safety. The recent consensus paper on Minimum Data Elements for Radiation Oncology highlights the importance of homogeneity in data definitions for safe care coordination. Previous editions of PRO have published articles on safety culture, incident learning and ASTRO white papers, including ones on Standardizing Dose Prescriptions and Standardizing Normal Tissue Contouring for Radiation Therapy Treatment Planning.
Add to the body of scientific literature on patient safety by conducting research and submitting original articles to PRO. Additionally, implement recommendations published in PRO, the Red Journal, Advances and other scientific journals.
There are many ways you can improve patient safety during PSAW and throughout the year. ASTRO encourages every practice and every member of the radiation oncology team to make safety a priority every day. Comment below with how you or your practice will be honoring this year’s awareness week.