3267 - Enhancing Quality and Efficacy in HDR Brachytherapy for Gynecological Cancers: A Multidisciplinary Approach by Using an Auto-Alert Information System and Innovative Solutions

Purpose/Objective(s):

The National Comprehensive Cancer Network (NCCN) guideline recommends completing radiotherapy (RT) for gynecological cancers, from external beam therapy to brachytherapy, within 8 weeks. However, HDR brachytherapy's complex procedures and patient-specific factors, such as radiation dermatitis and fatigue, often lead to delays. The present study aimed to improve HDR brachytherapy's quality and efficacy by implementing a quality-improving program and utilizing an information system.

Materials/Methods:

A comprehensive workflow analysis identified several bottlenecks causing delays of working flow. By using the Plan-Do-Check-Act (PDCA) approach and an auto-alert information system, we developed targeted interventions to increase working efficacy. Electronic workflow visualization tools improved transparency, while automated alerts and reminders ensured timely completion of key steps. A dual verification system by the radiation physics team enhanced accuracy, and a cross-system data-sharing platform improved multidisciplinary communication. Two key performance indicators included:

1. Achieve an 80%-time coincidence rate, according to the National Health Administration's "Cancer Diagnosis and Treatment Quality Certification Program."
2. Maintain a total item completion rate of 95%, as recommended by ICRU-24, ensuring errors remain below 5% of the prescribed dose.

Results:

The interventions led to significant improvements in key performance indicators. The time coincidence rate for HDR brachytherapy increased from 27.3% (3/11) to 100% (2/2; P < 0.0001) after implementing the quality improvement measures. The improvement was maintained until December 2024 in 83.8% (31/37; P < 0.0001). The total item completion rate of medical orders improved from 72.2% (783/1084 items) to 100% (180/180; P < 0.0001) after implementing the quality improvement measures. This 100% total item completion rate was sustained across all items (6128/6128) through December 2024, demonstrating the sustainability of the improvements. These results highlight the effectiveness of combining technological tools with a structured quality improvement approach to address workflow inefficiencies and improve patient outcomes.

Conclusion:

By using an information system, featuring auto-checks and alerts, significantly enhanced the efficiency and safety of HDR brachytherapy in patients with gynecological cancers. Integration into standard operating procedures ensured sustainability, with multidisciplinary collaboration being pivotal. Future efforts aim to extend these quality improvements to other radiotherapy departments, maximizing institutional benefits.