DOS 752 - Week 6 Discussion
Research your facility's CQI Program. What are the components of the program? Who is the team in your department? What processes are evaluated? What are the components of the program within your department? How does QA fit into this CQI program?
If you feel it's lacking (meaning they only do QA), how can this be implemented or improved at the site?
Post: Continuous Quality Improvement
The Department of Radiation Oncology at Loyola University Medical Center has a robust quality program with both Quality Assurance (QA), and Continuous Quality Improvement (CQI) components. The QA component of the overall quality program focuses on maintenance of existing quality levels, while the CQI components tries to keep raising the bar to higher and higher levels of quality.
The QA program is largely the domain of the physics staff, but therapists, nurses, dosimetrists, and administrators have roles to play as well (Anil Sethi, Oral communication, December 9, 2015). The most recognizable parts of the QA program are the daily, monthly, and annual calibration and testing of the linear accelerators, on-board imaging systems, CT simulator, brachytherapy equipment, and dose measurement devices. One of the less obvious QA activities is external auditing of beam output with thermoluminescent dosimeters that are sent to the Imaging and Radiation Oncology Core (IROC) at MD Anderson for verification of dose. Imaging system energy output is also checked annually by consulting physicists for state certification.
Besides checking machinery, documentation is also checked regularly for errors, omissions, and general quality. Every active patient chart is checked by a physicist prior to treatment, every week during treatment, and after treatment has been completed. Every time on-board imaging is used to capture a set-up image for treatment, the fusion of that image with the corresponding planning image is stored and checked by a physician to ensure the quality of the setup.
The CQI program also has several parts to it. Every day at lunchtime, there is a contour and plan review session that physicians, physicists, dosimetrists, and therapists attend. Once a patient's target volumes have been drawn, either by a resident or by an attending physician, the target contours are peer-reviewed, and suggestions may be given if improvements can be made. This is also an opportunity for physicians to share opinions or new research results that are relevant to the cases being discussed. If a physician is weighing several options for treatment, this is also a good time to seek opinions for peers. Similarly, if a physician is unsure about plan, they can present a completed plan at these conferences to seek peer feedback. These conferences improve the quality of the entire planning process as attendees absorb new information about planning and treatment techniques.
Another component of the CQI program is a quarterly morbidity and mortality conference, which is attended by one representative from each group in the department. Patients who have suffered significant or unexpected side-effects or harm from their treatments are discussed, and their records are reviewed in an attempt to determine whether it was due to random chance or some problem that may have happened during treatment or planning of the treatment. This root cause analysis is useful for identifying areas for improvement, and it may reveal blind spots in existing QA programs. As similar activity to this is quarterly review of reported incidents and near-misses. Near-miss reporting is an important part of the quality program, because incidents that were caught before they happened may be important for identifying ways to prevent similar incidents from ever happening.
I was already aware of many of these aspects of Loyola's quality program before compiling them for this assignment, but I had not realized how many of them there were and how they interact with one another to provide a high level of care that keeps getting higher.