Transcript Radiation Oncology Standards and the Standards Trial

Radiation Oncology Practice
Standards in Australia
Tomas Kron
On behalf of the Radiotherapy Tripartite Standards
Working Party
What is Quality Assurance?
• “All those planned and systematic actions
necessary to provide confidence that a
product or service will satisfy given
requirements for quality.”
ISO 9000
Public
Patients
Certification
Requirements
Needs
Organisation
Hospital
Assessment
Professions
Overview of the presentation
• Background
• Development of Radiation Oncology
Practice Standards
• Pilot of the Standards
• Discussion of the Standards, particularly
with reference to Incident Reporting
• Outlook
Background
• 2002 Baume Inquiry:
AHMAC
CTEPC
RORIC
RORIC
QWG
• led to formation of Radiation Oncology
Reform Implementation Committee (RORIC)
formed under the auspices of the Australian
Health Ministers’ Advisory Council’s
(AHMAC) Clinical, Technical and Ethical
Principal Committee (CTEPC)
• recommended a Quality Framework for
Radiation Oncology
• the Quality Working Group (QWG) is a
subcommittee of RORIC
Quality Framework
QUALITY IMPROVEMENT
STANDARDS
Such as incident
monitoring
Development
(or refinement) of Standards
or Guidelines
QUALITY ASSURANCE
ASSESSMENT
Such as regular
dosimetric auditing
Conformity assessment against
standards
Development of Radiation
Oncology Standards
• 2005 – Commonwealth funding to Tripartite Committee
through RANZCR to draft best practice standards
• Initial draft by commissioned authors and compilation by a
professional standards writing team
• 2007 – Initial drafting completed (> 300 indicators…)
• 2008 – representatives from the three key professions
collaborated to refine and simplify the initial draft standards
• Drafting coordinated by the Tripartite Committee with
support of the Radiation Oncology Reform Implementation
Committee’s (RORIC) Quality Working Group (QWG)
Development of Radiation
Oncology Standards
• Revised draft standards covered facility management;
treatment planning and delivery; and safety and
quality management
• September 2008 - consultation on revised draft
standards
• Standards released to every radiation oncology facility
and relevant industry and professional groups for
comment
• May 2009 – revised draft standards endorsed by RORIC
Every standard has the same
structure
• Standard
• Criteria (where and how is it applied)
• Commentary (key references,
comments)
• Required evidence (suggested)
Trialling Standards
• June 2009 – National Association of
Testing Authorities, Australia (NATA)
engaged by the Commonwealth to
conduct trial of the draft standards
• January – December 2010: Trial
• Purpose of trial was to assess the
functionality (and cost of compliance) of
the standards
Trialling Standards
• A steering committee was assisting the
Commonwealth to oversight the project
• Data was being collected through:
• on-line self assessment questionnaire;
• follow up on-site visit; and
• focus group meeting
• Methodology is broadly consistent with
assessment strategies used in other healthcare
settings
Trialling Standards
• Nine organisations (14 facilities) participated in
the trial:
State
TOTAL
Metro
Regional
Public
Private
VIC
4
2
2
2
2
NSW
4
3
1
2
2
QLD
1
1
TAS
2
1
SA
3
3
14
10
1
1
4
2
2
1
9
5
Trialling Standards
• Data collected includes:
• Feedback on appropriateness and clarity of
standards
• Extent to which facilities have the proposed
required evidence
• An estimate of the cost of meeting the
standards
KEY FINDINGS
• 1.2.1 The content and expression of the
Standards
• The feedback from the participating sites about the
merits of the Standards was positive. Based on that
feedback, no changes are required to the substance of
each Standard.
• In order to improve the useability, practicality and
functionality of the Standards for implementation
across the sector the feedback from the trial sites
indicates the need for some amendments to the detail,
particularly to the statements of the ‘required evidence’
for demonstrating compliance.
How far are standards met
already?
Percentage (%)
Average Availability of Required Evidence
for all Sites
100
90
80
70
60
50
40
30
20
10
0
Site Site Site Site Site Site Site Site Site Site Site Site Site Site
A
B
C
D
E
F
G
H
I
J
K
L
M
N
Other Findings
• 85% of the effort required to meet the
standards is already part of everyday
practice
• the standards requiring the most ongoing effort are:
• Workforce profile (Standard 2)
• Facility infrastructure (Standard 5)
• Radiation safety (Standard 13)
• Cost about 1FTE per centre
Finalizing the standards
• Small working
party implements
feedback from the
trial
• Final product
released in two
volumes:
• Standards
• Supporting
material
I. Facility
Management
1. STAFF
2. WORKFORCE PROFILE
3. MANAGEMENT OF RADIATION
ONCOLOGY RECORDS
4. DATA MANAGEMENT
5. FACILITY INFRASTRUCTURE
6. FACILITY PROCESS MANAGEMENT
7. EQUIPMENT
The standards: II. Treatment
Planning and Delivery
8.
RADIATION TREATMENT
PRESCRIPTION
9. PLANNING PROCEDURES
10. DOSIMETRY
11. RADIATION TREATMENT
DELIVERY
The standards: III.
Safety and Quality
Management
12.
13.
14.
15.
16.
SAFETY, QUALITY AND
IMPROVEMENT PROCESSES
RADIATION SAFETY
INCIDENT MONITORING PROGRAM
DOSIMETRIC INTERCOMPARISON
CLINICAL TRIALS PARTICIPATION
ACDCS
Bulk of work required to
meet required evidence
14(b)
Other features of the standards
Summary
• The development of the standards was
much more complicated than thought (at
least by me)
• Outside help was essential
• It had a very positive effect on bringing the
professions together
• Incident reporting is an essential aspect
Outlook
• ? Formal Assessment against the
standards ?
• ? RT centre accreditation ?
• Standards to be used when establishing
new centres
• Standards part of teaching and training
• ? International harmonization ?
Acknowledgements
•
•
•
•
•
Facilities participating in the Trial
Tripartite Committee & RANZCR
Tripartite Standards Working Group
NATA
Commonwealth Department of Health and
Ageing
• Colleagues from Pathology