Quality Assurance of QA Rounds: A Prospective Audit Tracks Practice Performance

Proceedings of the 50th Annual ASTRO Meeting Results: A total of 1,165 discharges from hospital were analyzed. Overall median age was 64 years, and median length of stay was 10 days. The top 3 primary malignancies were: Respiratory 26%, Gyne 15%, Head and Neck 12.4%. All other cancer diagnoses individually accounted for less than 10% of admissions. The longest median length of stay was 33.5 days for patients with CNS primary, next longest was a median stay of 17 days for head and neck patients. Overall, 62% of patients had at least 1 pre-existing co-morbidity, and 48.5% had metastatic disease. While 22% had new co-morbid disease diagnosed, and 26% had an adverse event during their admission. 24 patients required SCU care, and 6 of those patients died in hospital. Head and Neck patients had the highest percentage of patients with pre-existing co-morbid disease at 83%. They also had the most patients diagnosed with new co-morbidities during their admission at 45%. They had the most adverse events, or complications, at 54%. Despite the wide variety of patients and their varied medical problems, overall only 10% died. While 65% were discharged home, 18% to other hospitals, and 7% went to other care facilities. Conclusions: The majority of patients admitted to our hospital service have varied and complex medical problems that challenge clinicians. Adverse events and complications from therapy impact over 25% of admissions, and 2% required SCU care. Overall, 48% of patients suffer from newly diagnosed co-morbid conditions and complications which significantly impact their course in hospital. Head and Neck cancer patients appear to be especially prone to complications and adverse events. However, the majority of all patients were discharged home, even if they required SCU care. The perception that cancer patients admitted to hospital will do poorly and will not return home does not hold up upon review of our experience with 1165 discharges over a 5 year period. Author Disclosure: B.L. Brunet, None; P. Craighead, None; E. Kurien, None.

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Quality Assurance of QA Rounds: A Prospective Audit Tracks Practice Performance

G. M. Kane, K. Kelly, J. Rockhill, U. Parvathaneni, S. Patel, J. Douglas, J. Liao, M. Phillips, G. Laramore University of Washington, Seattle, WA Purpose/Objective(s): Weekly ‘‘chart rounds’’ afford an opportunity for peer review of treatment plans and thus are integral to the quality assurance (QA) process for many radiation oncology (RO) practices. They can provide valuable teaching for residents, but are less likely to be considered as continuing medical education or practice improvement activities. To address this issue, a prospective audit of chart rounds was conducted to examine the content of these rounds, and identify issues in the practice that were recurring and problematic. Materials/Methods: A spreadsheet was developed iteratively, and completed by 2-3 rounds participants each week to record the demographic and technical data (target volumes, isocenter, dose and technique) on each completed plan, and whether or not it met evidence-based standards of care (SOC). Issues raised in the discussions were also noted on the spreadsheet, as were as the measures devised to correct any identified problems. Content analysis was performed on 11 weeks worth of collected data. Results: Rounds were well attended, with an average of 6 (out of 8) RO faculty, 4 residents (out of 5), but few (1-2 for each professional group) dosimetrists, physicists and technologists. A mean of 11.2 cases were presented per week including all radical and palliative plans. Most cases met SOC. These that did not were cases too rare to have defined standards; treatment approaches were justified by the attending and critiqued by the group. Changes were made to 4.5% of plans. Content analysis of the resulting discussions identified 3 dominant themes; a) knowledge gaps, b) technical issues, and c) organizational concerns. The discussions referred to RO evidence-based sources, frequently verified on-line immediately, and identified new knowledge gaps. Plans were made for subsequent content-specific educational activities (e.g., rounds, resident presentations), or new research projects. Treatment and technical issues (e.g., immobilization devices for obese patients; gamma knife limitations) were followed up until resolved. Areas for improvement in the practice organization were frequently identified; changes (e.g., new RT booking process) were implemented and outcomes tracked. Conclusions: When outcomes of learning and organizational change are tracked longitudinally using this format, Chart Rounds provides basic QA and checks that SOC are met. However, this type of audit also provides a template for other group practices to track opportunities for further learning, and system and organizational improvement, and is consistent with the principles of performance improvement promoted by ACCME/AMA for CME. Author Disclosure: G.M. Kane, None; K. Kelly, None; J. Rockhill, None; U. Parvathaneni, None; S. Patel, None; J. Douglas, None; J. Liao, None; M. Phillips, None; G. Laramore, None.

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A 3+ Year Implementation/Evaluation of Tumor Board Conferences in a Community Radiation Oncology Setting

S. M. Rakfal, M.D, FACRO,1, S. Palepu, M.D., FACS,2, L. L. Schenken, Ph.D.,3, E. M. Ricci, PhD4 1 Chair and Medical Director-Department of Radiation Oncology, UPMC McKeesport Hospital, McKeesport, PA, 2General Surgeon and Co-Chair Tumor Board Program UPMC McKeesport Hospital, McKeesport, PA, 3UPMC McKeesport Hospital ROCOG Professional Development, McKeesport, PA, 4Director-Evaluation Institute-University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

Purpose/Objective(s): Starting in the 1970’s with the decline of the local steel industry, many community- based cancer treatment facilities in the Pittsburgh area suffered dramatic drops in facility utilization caused by both complex community changes and by healthcare reorganizations. McKeesport Hospital, once a large and prosperous suburban facility, saw the oncology staff and filled beds dwindle. A merger of the hospital with the University of Pittsburgh Health System was followed by reinforcement of community cancer care through the infusion of resources and support. Revitalization: We planned in 2004 to rebuild/enhance oncology services including shoring up Tumor Board as a Professional Development commitment. Materials/Methods: We started a program (October 2004 - 2007) emphasizing ownership, teamwork, multidisciplinary approaches, convenience, evidence based case reviews and educational presentations for all elements of cancer diagnosis and management.

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