MSOR9 Presentation Time: 5:40 PM

Abstract

Purpose

In a radiation oncology (RO) clinic, brachytherapy (BT) is a time and resource intensive modality. Constraints to efficiency and throughput include physical resources: afterloader and vault availability, applicator inventory, and OR availability but also physician and support staff availability to maintain efficiency. Thus, several things need to be considered when scheduling cases and having a BT team with each member given their defined roles is essential. The goal of utilizing a BT procedure daily scorecard is to ensure adequate resource allocation and minimize the risk of burnout that could potentially lead to employee dissatisfaction, patient safety events, or turnover on the BT team. Utilizing a similar scorecard method will also be useful to radiation oncologists and RO clinics worldwide when starting or grow a BT program.

Methods

Each BT procedure was given a score ranging from 1 - 3 (Table 1) based on complexity. A score of 1 was allocated to procedures that were relatively less labor intensive. A score of 2 was given to procedures that required a treatment plan on the day of implant and nursing care. A score of 3 was given to procedures that required BT team members to be in the OR for pre-procedure setup and implantation or implants with longer procedural, treatment planning, and delivery times. The total BT score was limited to no more than 10 on any given day when creating a BT schedule with additional review required for schedules exceeding a score of 10 to allow for appropriate staffing. A retrospective analysis was performed analyzing the number of cases, average start/end time, the average BT score, and the average difficulty per case for 3 months pre-implementation and 3 months post-implementation.

Results

Implementing a daily BT procedural scorecard improved BT procedural efficiency without compromising procedural throughput. Despite maintaining a similar average difficulty of cases performed (1.85 vs 1.78 ±0.47), the clinic time spent in BT was reduced along with the score of the day (9.1 vs 6.87). Utilizing the scoring system may also improve BT team morale due to decreased daily case complexity, shortened hours, and through appropriate procedural staffing.

Conclusion

We show utilizing a BT scoring system can improve efficiency of BT workflow without compromising patient throughput. Strategies such as this may help BT clinics improve schedule organization, employee satisfaction, staffing models, and should be considered in all high-volume BT clinics.