3321 - Operational Time Savings with Prospective Peer View
Presenter(s)
S. Quirk1, T. K. Kosak2, M. Kearney3, D. Ribok2, C. V. Guthier1, S. Yu1, D. E. Kozono1, N. E. Martin1, and L. Warren1; 1Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 2Brigham and Women's Hospital, Boston, MA, 3Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA
Purpose/Objective(s): Number needed to treat is a concept in evidence-based medicine to assess the effectiveness of an intervention by the number of patients that need to receive a specific intervention to prevent one negative outcome. Here, we apply this concept to prospective peer review where we propose a “time needed to review (TNR),” defined as the person-time required in peer review to prevent a case replan based on a measured error detection rate.
Materials/Methods: An institutional quality initiative implementing disease-specific peer view began in Summer 2024 across one academic medical center and four affiliated regional community sites. Patients with thoracic malignancies comprised the first patient cohort. One hypothetical operational efficiency to be gained with prospective peer review is the opportunity to identify clinically-meaningful changes upstream such that replanning is not required should the same suggested change be retroactively identified after the patient starts treatment. There were daily 30-minute peer review sessions four times per week with a required quorum of two radiation oncologists and one medical physicist. Attendees reviewed each plan, including feedback indicating “must change,” defined as prompting a mandatory hold in treatment planning until the change was made. Contours were reviewed prior to planning and plans prior to treatment start. Data including the number of patient cases, time per case, and error detection rates were recorded. The TNR was calculated as: ((time per case) x (individuals required for peer review))/(must change rate). This framework was then extended to explore and predict how different case throughput and error detection rates impact the TNR. To assess the potential for operational time savings, the estimated time saved for every replan avoided was four hours.
Results: During the first 25-weeks of prospective thoracic peer review, the mean number of cases per week was 18.4, the time per case was 0.1 hours, three individuals were mandatory attendees for peer review, and the must change rate was 8.4%. Based on these clinical values, the TNR was 3.6 hours. If the time required to review each case decreases to 0.05 hours but the error rate remains the same, then the TNR decreases to 1.8 hours. If the error rate decreases to 5% and each case requires 0.05 hours to review, the TNR is 3.0 hours.
Conclusion: Disease-specific peer review identified an 8.4% mandatory change rate. The number of people-hours required to identify one plan requiring mandatory change was 3.6 hours. Compared to an estimated four hours to replan a case, prospective peer review was operationally time saving. This proposed concept of “time needed to review” can be used to model potential time savings in other disease sites and clinical settings.