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• W2016110629 abstract "Purpose/Objective(s)Accurate delivery of radiation therapy (RT) is a complex process involving staff and personnel from various disciplines. Although multiple, independent verifications of treatment plans are commonplace, errors in treatment planning or delivery can still occur. Additional automated safety mechanisms using the electronic medical record could improve patient safety. Here we propose a mechanism which cross-references the patient diagnosis with common dose and fractionation schemes to identify RT prescriptions (Rx) which may be infrequent or aberrant. The long term goal would be to implement cross-referencing into RT electronic physician order entry systems to provide an added level of patient safety.Materials/MethodsData from 470 ICD9 linked Rx was analyzed from four sites, including 177 Rx for Esophagus (ICD9 150), 114 Rx for Bladder (ICD9 188), 92 Rx for Cervix/Uteri (ICD9 180), and 87 Rx for Hodgkin Lymphoma (ICD9 201). The frequency of each unique Rx (dose x fractions) was plotted for each site. Analysis of data from 2007 to 2011 identified the Rx which were used for these sites. This data was used as a reference control to analyze ICD9 Rx entered during the period from 4/2011 to 3/2012. A program was designed which cross-referenced the frequency of a given Rx within the test period compared to the reference control period. RT Rx were flagged if a dose and fractionation scheme had never been prescribed for that site or was infrequent for that site (i.e., <1% or <5%).ResultsThere were 4 recurring Rx (3.7%) found to be infrequent at the <1% cutoff level. There were 24 Rx (22%) found to be infrequent at the <5% cutoff level. Interestingly, there were 26 unique Rx which had not been prescribed previously during the reference control time period. Investigation into these unique Rx identified multiple etiologies including: new technique (15/26), unique palliative dosing (7/26), incorrect/multiple ICD9 specifications (3/26), and undeliverable Rx (1/26).ConclusionOur analysis demonstrates that it is feasible to cross-reference RT Rx to ICD9 linked diagnoses to identify dose-fractionation schemes that are infrequent for a given diagnosis and require further investigation by the RT team. Implementation of a cross-referencing system during order entry of RT Rx could also alert the physician to infrequently used Rx for a given diagnosis thereby providing an additional level of consistency of care across patients and by physicians working in one practice. Purpose/Objective(s)Accurate delivery of radiation therapy (RT) is a complex process involving staff and personnel from various disciplines. Although multiple, independent verifications of treatment plans are commonplace, errors in treatment planning or delivery can still occur. Additional automated safety mechanisms using the electronic medical record could improve patient safety. Here we propose a mechanism which cross-references the patient diagnosis with common dose and fractionation schemes to identify RT prescriptions (Rx) which may be infrequent or aberrant. The long term goal would be to implement cross-referencing into RT electronic physician order entry systems to provide an added level of patient safety. Accurate delivery of radiation therapy (RT) is a complex process involving staff and personnel from various disciplines. Although multiple, independent verifications of treatment plans are commonplace, errors in treatment planning or delivery can still occur. Additional automated safety mechanisms using the electronic medical record could improve patient safety. Here we propose a mechanism which cross-references the patient diagnosis with common dose and fractionation schemes to identify RT prescriptions (Rx) which may be infrequent or aberrant. The long term goal would be to implement cross-referencing into RT electronic physician order entry systems to provide an added level of patient safety. Materials/MethodsData from 470 ICD9 linked Rx was analyzed from four sites, including 177 Rx for Esophagus (ICD9 150), 114 Rx for Bladder (ICD9 188), 92 Rx for Cervix/Uteri (ICD9 180), and 87 Rx for Hodgkin Lymphoma (ICD9 201). The frequency of each unique Rx (dose x fractions) was plotted for each site. Analysis of data from 2007 to 2011 identified the Rx which were used for these sites. This data was used as a reference control to analyze ICD9 Rx entered during the period from 4/2011 to 3/2012. A program was designed which cross-referenced the frequency of a given Rx within the test period compared to the reference control period. RT Rx were flagged if a dose and fractionation scheme had never been prescribed for that site or was infrequent for that site (i.e., <1% or <5%). Data from 470 ICD9 linked Rx was analyzed from four sites, including 177 Rx for Esophagus (ICD9 150), 114 Rx for Bladder (ICD9 188), 92 Rx for Cervix/Uteri (ICD9 180), and 87 Rx for Hodgkin Lymphoma (ICD9 201). The frequency of each unique Rx (dose x fractions) was plotted for each site. Analysis of data from 2007 to 2011 identified the Rx which were used for these sites. This data was used as a reference control to analyze ICD9 Rx entered during the period from 4/2011 to 3/2012. A program was designed which cross-referenced the frequency of a given Rx within the test period compared to the reference control period. RT Rx were flagged if a dose and fractionation scheme had never been prescribed for that site or was infrequent for that site (i.e., <1% or <5%). ResultsThere were 4 recurring Rx (3.7%) found to be infrequent at the <1% cutoff level. There were 24 Rx (22%) found to be infrequent at the <5% cutoff level. Interestingly, there were 26 unique Rx which had not been prescribed previously during the reference control time period. Investigation into these unique Rx identified multiple etiologies including: new technique (15/26), unique palliative dosing (7/26), incorrect/multiple ICD9 specifications (3/26), and undeliverable Rx (1/26). There were 4 recurring Rx (3.7%) found to be infrequent at the <1% cutoff level. There were 24 Rx (22%) found to be infrequent at the <5% cutoff level. Interestingly, there were 26 unique Rx which had not been prescribed previously during the reference control time period. Investigation into these unique Rx identified multiple etiologies including: new technique (15/26), unique palliative dosing (7/26), incorrect/multiple ICD9 specifications (3/26), and undeliverable Rx (1/26). ConclusionOur analysis demonstrates that it is feasible to cross-reference RT Rx to ICD9 linked diagnoses to identify dose-fractionation schemes that are infrequent for a given diagnosis and require further investigation by the RT team. Implementation of a cross-referencing system during order entry of RT Rx could also alert the physician to infrequently used Rx for a given diagnosis thereby providing an additional level of consistency of care across patients and by physicians working in one practice. Our analysis demonstrates that it is feasible to cross-reference RT Rx to ICD9 linked diagnoses to identify dose-fractionation schemes that are infrequent for a given diagnosis and require further investigation by the RT team. Implementation of a cross-referencing system during order entry of RT Rx could also alert the physician to infrequently used Rx for a given diagnosis thereby providing an additional level of consistency of care across patients and by physicians working in one practice." @default.
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• W2016110629 title "Automated Cross-Referencing of Radiation Prescriptions to Diagnosis: A Proposed Mechanism to Improve Patient Safety" @default.
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