Quality management in radiotherapy: A 9-year review of incident reporting within a multifacility organisation

Abstract

Background: A radiotherapy incident reporting system should (1) record and classify incidents, (2) assess the impact of incidents on patients in terms of dose errors and (3) identify areas of improvement in the incident reporting system. Such a system at the Independent Clinical Oncology Network (ICON) Oncology is investigated.

Aim: An ‘incident’ is defined by ICON as ‘any occurrence that may prevent the patient from receiving the prescribed dose in the prescribed time period or may cause unplanned harm to the patient or may infringe upon the patient’s rights’.

Setting: Incidents reported between December 2011 and December 2020.

Methods: Incidents were analysed looking at various factors such as institutional timelines compared with major projects, incident error and areas, reporting frequencies amongst tumour-sites and professional groups.

Results: Over the course of 9-years, 78 521 patients were treated at ICON’s centres and a total of 924 reports were filed involving 1355 patients. This shows an incident rate of 1.7% of all patients in radiotherapy. The difference in incident number versus patients is because one incident may involve many patients. Reporting amongst professional groups has more distinctive differences, with 86.0%, 11.6% and 2.4% reported cases per annum for radiotherapists, physicist and oncologist, respectively. For the errors in dose-delivery, 43.0% of the incidents were discovered with no dosimetric or clinical consequence, 53.6% with dosimetric consequence but no clinical consequence and 3.4% with dosimetric and clinical consequence.

Conclusion: Incident reporting is not a new quality assurance (QA) indicator for radiotherapy treatment. However, it requires continuous effort and innovation to uphold and maintain a high standard of patient and staff safety within an organisation. Errors are present during every stage of the radiotherapy process, whether it be human, technical, organisational or patient related. From the statistics of all the patients treated at ICON, 0.04% have been reported to have had an associated incident that involved some form of clinical consequence. Yet, if undetected, the incident could lead to increase in dose errors to patients.