An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster Mallalieu, A Kapur, A Sharma, L Potters, A Jamshidi, J Mogavero, J Pinsky North Shore - Long Island Jewish Health System
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An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.
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An electronic whiteboard and associated databases for physics
workflow coordination in a paperless, multi-site radiation oncology
department
L Brewster Mallalieu, A Kapur, A Sharma, L Potters, A Jamshidi, J Mogavero, J Pinsky
North Shore - Long Island Jewish Health System
Motivation for Physics Process Control
• FMEA analysis: physics tasks among the
highest risks
• Process delays cause potential safety risks
• Coordination of physics activities in a multi-
site department challenging
Commercial EMR system provides:
• Process flow mapping with customized Quality
Check Lists
• Task completion checked and dated
EMR system doesn’t provide:
• Summary views of physics task status for all patients,
all physics staff
• Efficient determination of root causes of delays in
physics tasks
• Statistical analysis of process control with
performance metrics
Tools for Process Control
Issue Addressed Database Tool Physics work coordination Physics Whiteboard
Root Cause Analysis of delays QA Monitoring Database
Machine problem monitoring Machine Whiteboard
RCA-based changes to department policy
Policies and Procedures Database
Physics whiteboard
• MS Access user interface to SQL database
• Monitors all planning tasks in summary view
• Coordination of planning assignments, staff
workload tracking
• Delays flagged with an ON HOLD status
Physics whiteboard
Whiteboard reporting and analysis functions
• Staff workload distribution
• “Slip Days” metric for Six Sigma analysis:
mean, standard deviation, histograms
• Analyze delays by plan type, disease site, staff,
etc.
Slip Days Analysis of Physics Tasks2nd Plan Check Slip Days
0
0.5
1
1.5
2
2.5
3
3.5
4
Oct-09 Jan-10 May-10 Aug-10 Nov-10 Feb-11 Jun-11
mean
std dev
Plan Completion Slip Days
-2
-1
0
1
2
3
4
Oct-09 Jan-10 May-10 Aug-10 Nov-10 Feb-11 Jun-11
mean
std dev
1st Day Physics Check Slip Days
0
0.5
1
1.5
2
2.5
Oct-09 Jan-10 May-10 Aug-10 Nov-10 Feb-11 Jun-11
mean
std dev
IMRT QA Slip Days
-0.5
0
0.5
1
1.5
2
2.5
3
3.5
Oct-09 Jan-10 May-10 Aug-10 Nov-10 Feb-11 Jun-11
mean
std dev
Machine whiteboard: track
and analyze equipment issues
QA monitoring database
• QA incidents reported by staff
• Cross-functional QM team analyzes incidents
to determine root causes and suggest
improvements
• Reviewed incidents broken down using a
hierarchical causes data structure
QA Monitoring Incident Review
Identification of root causes for “Plan not ready for treatment start” incidents
Planning procedure delays
Contouring delay: 46% Plan modification: 33% Insufficient time: 20%
Image fusion 43% Recontouring 45%
Rx or constraint mod. 29%
Tx machine issues 11%
MD scheduling issue 37%
MD peer review 13%
Policies and Procedures• QM analysis leads to
new policies
• Database for policy
documents, review and
editing by staff
• New policy disseminated
to staff via in-service and
department blog
Conclusions
• EMR doesn’t easily provide workflow coordination and
RCA forensics
• Additional database tools have provided process
control data analysis for ongoing streamlining of
physics workflow
• Future: Consolidated, web-based, with electronic