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Quality improvement report
Reducing prolonged chemoradiation treatment times for cervical cancer
  1. Lucas Vitzthum,
  2. Jianling Yuan,
  3. Daniel Jones,
  4. Anne Boldt,
  5. Kathryn Dusenbery
  1. Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Kathryn Dusenbery; dusen001{at}umn.edu

Abstract

Prolonged total treatment times (TTTs) beyond 56 days are associated with worse outcomes for cervical cancer treated with radiation therapy. We reviewed treatment times in a cohort of 24 consecutive patients treated with definitive chemoradiation (CRT) at our institution and found that only 14 patients (58.3%) completed treatment in less than or equal to 56 days. The primary objectives of this institutional quality improvement initiative were to identify sources for delays in treatment completion and to implement effective measures in an effort to minimise prolonged TTT. Pareto plot and process mapping were used to identify and resolve root causes of prolonged treatment. The Plan-Do-Study-Act method was then implemented to reduce treatment duration. Post-intervention treatment times were prospectively evaluated in 81 subsequent patients treated with definitive CRT. Process mapping identified inefficiencies with scheduling, staggered treatments and inadequate patient and staff education. Institutional changes were implemented, heavily utilising oncology nurses’ skill set in staff re-education and care coordination. Our workflow was redesigned to reduce/eliminate treatment delays. These interventions led to a significant improvement in the percentage of patients meeting the goal TTT compared with the pre-intervention cohort (85.2% vs 58.3%, p<0.01), and results were sustainable in additional 47 patients prospectively followed subsequently, potentially making a positive impact on their treatment outcomes.

  • Women's health
  • Team training
  • Standards of care
  • Root cause analysis
  • Quality improvement

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2018-000516

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    Footnotes

    • Presented at Portions of this work were presented in poster format at the American Society of Therapeutic Radiation Oncology Annual Meeting, 15 September 2014, San Francisco, California, USA.

    • Contributors LV contributed to the project design, implementation, data collection, data analysis and manuscript preparation. JY contributed to the project design, QI implementations, manuscript preparation and editing. AB contributed to data collection, QI implementations, QI brainstorming and manuscript editing. DJ contributed to the project design, implementation and manuscript editing. KD contributed to the project conception and design, staff interviewing, QI implementations, manuscript writing and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.