Quality and Safety in Stereotactic Radiosurgery and Body Radiation Therapy
Stereotactic radiosurgery (SRS) has been an effective modality for the treatment of benign and malignant cranial disease for over 50 years and both; stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) require specialized technology, meticulous procedures, and dedicated personnel (Solberg & Medin, 2010). There are an abundance of guidance to assist practitioners in providing accuracy and precision for a high quality of service, nonetheless, the high-dose nature of SRS/SBRT suggests a potential for increased rate and severity of adverse clinical events when treating patients.
According to the Nuclear Regulatory Commission (NRC) Radiation Event Report Notification database, it listed the events of radiosurgery reporting from period of 2005-2010, where implications took place such as: patient orientation entered incorrectly at MR scanner and treated wrong location, improperly CT imaging in treating wrong part of the body, physician mistakenly typed wrong doses into the planning system which in turn created the wrong dose delivered, and physicist calculated erroneous prescription and created a wrong dose for treatment and delivery implication (Solberg & Medin, 2010).
The NRC estimates about 60% or more of radiosurgery and/or radiotherapy misadministration are due to human error; therefore, the World Health Organization (WHO) along with the International Commission on Radiological Protection (ICRP), the National Health Service (NHS) of the United Kingdom and the Alberta Heritage Foundation for Medical Research provided a list of some of the common factors contributing to radiotherapy incidents. Such factors contributing to the incidents are as follow but not limited to: lack of training,
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inadequate staffing, stress, poor design, procedures, documentation, complexity and sophistication of new technologies. In addition to those factors, poor communication and lack of team work were the biggest factors for the incidents, therefore the inadequate infrastructure and work environment must be change for a safer process (Solberg & Medin, 2010).
The WHO has recommended a general preventative measure in reducing radiotherapy errors and such recommendations are as follows: an across organization quality assurance program to reduce systematic equipment risks and procedural errors; a peer review audit program where physicians must report any potential adverse action; a very precise and concise procedural method before executing any action; independent verification through all stages of the process; specific committees or leadership in charge of verifying competency certification for all staff; patient’s proposed course of treatment must or should be discussed and reviewed by the entire stereotactic team before proceeding execution; and standardize institutional procedures should be available and followed for every stage of the treatment process.
In order to have an efficient, safe and in alignment tool to cover such preventative measures, it is imperative to have in place the Electronic Medical Record (EMR) and Computerized Physician Order Entry (CPOE) systems. According to Varkey (2010), ‘The EMR is a means to establish a virtual data-information center to serve as a dynamic repository to enhance the ability of the advisory bodies and the staff to collect and to analyze data. This virtual data-information center can serve as a vehicle to promote and to disseminate standardized data definitions and best practices to providers, consumers, and others interested in quality improvement efforts nationally and internationally’ (p. 98). In addition, the CPOE assist the entire staff in communicating the appropriate departments, providers, and support staff over a
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computer network to decrease delay in order completion, reduce errors of legibility, and order duplication (Varkey, 2010).
In enhancing efficiency, safety and quality, the American health care system would be able to confront: quality, efficiency, safety and financial problems of underuse of services, overuse of services, misuse of services, variation of services, and sentinel events; which such reasons and actions are costing millions of dollars to all stakeholders and causing the death of many human beings due to quality and safety practice. In the same note, by establishing a Global Expectation of an Electronic Medical Record (EMR) system, it would provide physicians and medical staff with electronic documentation of patients events on both episodic and recurrences; it would serve as a single source of all information from conception to death; it would allow for just in time data availability for all care providers; it would allow data views that would accommodate the needs of unique users without creating data pollution; and it would combine with a data warehouse the data from multiple EMRs and applications in order to provide and determine best practice, appropriate guidelines for care and populations health improvements (Varkey, 2010).
In conclusion, by adopting in having a National and or Global EMR and Computerized Physician Order Entry (CPOE) in our National Health Care System, the quality forum would be able to accomplish the following: identify core sets of quality measures for a standardized reporting system/process in the health care industry; establish a framework and capacity for quality measurement and reporting; enhance and improve the ability to evaluate and improve quality and safety care; make recommendations for research and development needed to advance quality measurement and reporting; ultimately, ensure that comparative information on health
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care quality is valid, reliable, comprehensive, and widely available in the public domain (AHRQ, 2009).
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