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Patient Safety: Improved Pre-Treatment Coordination and Communication Through the Use of An Electronic Whiteboard in Radiation Oncology

W Bice*, John Muir Medical Center, Walnut Creek, CA


(Sunday, 7/29/2018) 3:00 PM - 6:00 PM

Room: Exhibit Hall

Purpose: To investigate suspected improvement of pre-treatment clinical work flow following the installation of an electronic whiteboard.

Methods: In our clinics the final chart checklist is completed by the treatment therapists. Safe patient delivery requires sufficient time be allotted to complete this extensive check. Lacking a national standard, our CQI metric was developed based on therapist staffing, patient load and check completion time: completed chart availability to the therapists more than 6 working hours prior to the scheduled start time. At one of our clinics, staff reports indicated difficulty in achieving compliance. An electronic whiteboard was developed in Aria to coordinate the imaging, planning, and QA processes. The effect, measured by the 6-hour metric, was tracked for a year, 2017, and compared to the year previous, 2016. To eliminate reporting bias in the measurement, the start of the 6-hour period was determined from Aria historical data as the completion of the previous task to determine the interval in working hours prior to the patient’s scheduled start time. After randomization, 10 patient starts per month from each year were analyzed—about ¼ of the clinical workload.

Results: After the installation of the whiteboard, compliance rates improved dramatically. An immediate drop in non-compliance (charts arriving at the treatment machine less than 6 hours prior to the start time) was noted. The difference in non-compliance rates in 2016 and 2017, respectively 56% and 15%, was significant (p< 0.001, KS test for normality and Student’s T-test for significance).

Conclusion: The 6-hour metric is a reasonable, achievable goal in a busy clinic. The whiteboard added valuable centralized communication and coordination to the pre-treatment work flow, significantly improving compliance with the 6-hour metric and, presumably, patient safety.


Quality Assurance


IM/TH- Formal quality management tools: General (most aspects)

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