Quantifying risk using FMEA: An alternate approach to AAPM TG-100 for scoring failures and evaluating clinical...

Area of Science:

• Medical Physics
• Radiation Oncology
• Quality Improvement

Background:

• Brachytherapy programs require rigorous evaluation of clinical workflows to ensure patient safety and treatment efficacy.
• The American Association of Physicists in Medicine (AAPM) Task Group 100 (TG-100) report provides a framework for assessing clinical workflow risks.
• Optimizing brachytherapy workflows is crucial for minimizing treatment failures and enhancing overall quality of care.

Purpose of the Study:

• To renovate a brachytherapy program by objectively evaluating clinical workflows using AAPM TG-100 methods.
• To develop techniques for minimizing failure modes, increasing efficiency, and improving treatment quality in brachytherapy.
• To assess the impact of differing methods for determining the risk priority number (RPN) beyond simple multiplication.

Main Methods:

• A team of 15 staff members evaluated a complex brachytherapy procedure's clinical workflow.
• Discrete failure modes (FM) were identified using alternate scoring scales, expanding beyond TG-100 recommendations.
• Weighted functions of staff perceptions were used to determine a more realistic measure of risk, enhancing scoring sensitivity and mitigating bias.

Main Results:

• The new risk assessment method expanded RPN possibilities by a factor of 86, improving workflow evaluation.
• Mean RPN values for each FM decreased by 44% (TG-100 method) and 66% (new method) with the revised workflow.
• The integral of RPN values, representing total workflow risk, showed a 15% increase with TG-100 and a 31% decrease with the new method.

Conclusions:

• This study represents the first known application of an alternative approach to the TG-100 method for clinical workflow risk evaluation.
• The developed method provides a more sensitive and realistic assessment of risks associated with clinical workflows.
• The findings exemplify effective risk analysis techniques for the rapid evaluation of clinical workflows in radiation oncology.