Adoption of an incident learning system in a regionally expanding academic radiation oncology department

Abstract

Aim and background: We describe a successful implementation of a departmental incident learning system (ILS) across a regionally expanding academic radiation oncology department, dovetailing with a structured integration of the safety and quality program across clinical sites.

Materials and methods m: Over 6 years between 2011 and 2017, a long-standing departmental ILS was deployed to 4 clinical locations beyond the primary clinical location where it had been established. We queried all events reported to the ILS during this period and analyzed trends in reporting by clinical site. The chi-square test was used to determine whether differences over time in the rate of reporting were statistically significant. We describe a synchronous development of a common safety and quality program over the same period.

Results: There was an overall increase in the number of event reports from each location over the time period from 2011 to 2017. The percentage increase in reported events from the first year of implementation to 2017 was 457% in site 1, 166.7% in site 2, 194.3% in site 3, 1025% in site 4, and 633.3% in site 5, with an overall increase of 677.7%. A statistically significant increase in the rate of reporting was seen from the first year of implementation to 2017 (p < 0.001 for all sites).

Conclusions: We observed significant increases in event reporting over a 6-year period across 5 regional sites within a large academic radiation oncology department, during which time we expanded and enhanced our safety and quality program, including regional integration. Implementing an ILS and structuring a safety and quality program together result in the successful integration of the ILS into existing departmental infrastructure.

Keywords: Incident learning; Regional expansion; Safety and quality.

Fig. 1

Events reported per year by clinical site from the first year of ILS use to 2017. The Y-axis represents absolute number of events reported per year by site.

Fig. 2

Volume of unique patients by clinical site (a) and volume of unique treatments by clinical site (b) from the first year of ILS use to 2017. The Y-axes represent the absolute numbers of patients and unique treatments per year by site.

Fig. 3

Variation in “reporting rate” over time. The event rate is calculated by dividing the number of event reports in a given year by the number of unique patients treated that year (a) and by the number of individual treatments delivered that year (b).