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![Page 1: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/1.jpg)
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
![Page 2: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/2.jpg)
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
![Page 3: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/3.jpg)
Commercial EMR system provides:
• Process flow mapping with customized Quality
Check Lists
• Task completion checked and dated
![Page 4: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/4.jpg)
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
![Page 5: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/5.jpg)
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
![Page 6: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/6.jpg)
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
![Page 7: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/7.jpg)
Physics whiteboard
![Page 8: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/8.jpg)
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.
![Page 9: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/9.jpg)
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
![Page 10: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/10.jpg)
Machine whiteboard: track
and analyze equipment issues
![Page 11: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/11.jpg)
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
![Page 12: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/12.jpg)
QA Monitoring Incident Review
![Page 13: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/13.jpg)
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%
![Page 14: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/14.jpg)
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
![Page 15: An electronic whiteboard and associated databases for physics workflow coordination in a paperless, multi-site radiation oncology department L Brewster.](https://reader036.fdocuments.us/reader036/viewer/2022062618/55145efd5503462d4e8b57e7/html5/thumbnails/15.jpg)
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
interface to EMR data