Patterns of practice for safety-critical processes in radiation oncology in the United States from the AAPM safety profile assessment survey

Abstract

Purpose: The purpose of this study is to report an overview of the patterns of practice for safety-critical processes in radiation oncology clinics in the United States.

Methods and materials: The Safety Profile Assessment (spa.aapm.org), developed by the American Association of Physicists in Medicine, was released in July 2013. It consists of 92 indicator questions designed to assess the safety and quality of radiation oncology operations. By December 2014, 114 surveys had been completed by clinics within the United States. This database was analyzed to identify those indicators of safety and quality performance with which there was the highest degree of compliance and those indicators with which there was the least. Additionally, we assessed the extent to which key clinical activities were supported by formal policies. Voluntary post assessment surveys were completed by 86 respondents (75%).

Results: The mean number of patients treated per day on external beam radiation therapy devices was 64 (range, 8-600) in the clinics that responded to the survey. The average overall score for the 92 SPA indicator questions was 1.45 (range, 1.00-2.78) on a 5-point scale, with 1 being the most positive. Those indicators that were associated with the highest levels of compliance are dominated by activities that are either strongly recommended, regulated, or associated with revenue generation. Surprisingly, several of those indicators for which there was the least compliance relate to activities that are known to have contributed to serious radiation therapy misadministrations in the past. Formal policies, which are widely regarded as a backbone of a safe clinical system, were reported as lacking for some safety-critical procedures.

Conclusions: Although overall this analysis demonstrated reasonable performance across participating departments, several important areas for improvement were identified. The results may guide the allocation of resources both at the level of individual departments and at the professional society level.