Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy
Menée à partir de données portant sur 1 293 patients ayant reçu une radiothérapie entre 2011 et 2013, cette étude identifie les facteurs prédictifs associés au risque d'incident de sécurité
Purpose : Patient safety is a vital concern in radiation therapy, but little is appreciated about factors that predict patients at risk for safety incidents. In this study, we aimed to a) describe cases during which voluntary incident reporting occurred, and b) identify patient or treatment-specific factors that place patients at higher risk for incidents.
Methods : We used our institution’s incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios and mixed-effect logistic regression models were used for group comparisons.
Results : The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%) and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18) than in adult patients (37.7 vs 0.4%, p<0.001). Patients with head and neck (16 vs 8%, p<0.001) and breast (20 vs 15%, p = 0.03) primaries more frequently had incidents, while brain (18 vs 24%, p = 0.008) primaries were less frequent. Larger tumors (17 vs 10% had T4 lesions, p = 0.02), and cases on protocol (9 vs 5%, p = 0.005) or with IMRT/IGIMRT (52 vs 43%, p = 0.001) were more likely to have incidents.
Conclusions : We found several treatment and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards in order to minimize safety risks.
International Journal of Radiation Oncology • Biology • Physics , résumé, 2014