My colleagues from Technology Insights just returned from this year's American Society for Radiation Oncology (ASTRO) meeting and had some interesting insights to share. The most visible theme at the meeting was a renewed focus on a culture of safety and evidence-based medicine. While certainly not a forgotten ideal, this topic has been ushered back into the limelight by the recently intensified scrutiny of this branch of oncology care. Beyond this focus on the collective mission and performance of the industry, a number of new technology developments and reimbursement updates emerged.
In addition to calls for practicing evidence-based medicine, many of the clinical presentations at this year's meeting addressed underlying concerns about safety within radiation therapy (RT)--an issue brought to light on the national stage earlier this year through a series of New York Times articles exposing errors--both human and technical--in radiation therapy and imaging procedures. In concert with these clinical presentations, ASTRO has also set into motion a plan and set of tools to assist providers in ensuring safe and high-quality care, which focuses on the following elements:
A. Communication: Presenters highlighted the wide range of stakeholders typically involved in RT procedures (i.e. radiology oncologists, medical physicists, dosimetrists, and technicians) as a complicating factor when it comes to safety. Put simply, the more people involved in a procedure, the greater opportunity for miscommunication and error. Strong lines of communication, hardwired "check-ins," and general camaraderie among stakeholders can help prevent error.
B. Compliance: In line with quality assurance standards, presenters stressed the need for standardized, department-wide compliance systems, particularly in light of increasing complexity within sub-specialties. Creating compliance systems and educating staff accordingly ensures that all RT stakeholders are on the same page and can help reduce the risk of practice errors.
C. Checklists: Presenters repeatedly cited checklists as meaningful tools for ensuring safety and preventing error in RT. However simplistic, checklists are an effective, low-cost, and easily-implemented means for breaking down the various elements and roles inherent in RT treatments that can help ensure that no step is overlooked. Interestingly, presenters stressed that checklists should not be interpreted as an indication of weakness or a lack of competency. Rather, they acknowledge human error and the highly complex nature of radiation therapy procedures. By clearly delineating the steps involved in an RT procedure and assigning responsibility for each role, checklists can be effective in minimizing human error due to distractions, miscommunication, or inadvertent omission.
The NAPBC has announced some changes to their standards which will be effective January 1, 2011. The one that caught my eye is they will require 80% of appropriate patients be referred for a plastic surgery consult. Unfortunately I can't find any additional details on the new standard, but this could raise the bar for programs seeking certification as securing access to plastic surgery consults can be particularly challenging, a fact we highlighted in our most recent work on breast cancer, Next-Generation Breast Cancer Strategy. Increasingly, plastic surgeons prefer to spend more of their time on cosmetic procedures, and thus are reluctant to dedicate time to reconstruction consults. Those programs seeking accreditation will likely need to start planning now to ensure they can achieve this new standard.