Increased frequency of remote and off-site work impacts incident learning workflows in radiation oncology

Incident learning is key to improving clinical quality and safety. This study evaluates the impact of workflow changes related to increasing remote work on incident learning in a radiation oncology clinic.

We analyzed reported event data for three 12-month intervals: pre-COVID (March 1, 2019 - February 29, 2020), during-COVID (March 1, 2020 - February 28, 2021), and COVID-adapted (March 1, 2021 - February 28, 2022). Events were prospectively analyzed by our multi-disciplinary Quality and Safety Committee using an electronic incident learning system capture system. We evaluated event reporting rates, severity, associated/contributing factors, point of event origin and detection. Descriptive statistics and chi-square tests were used to compare characteristics between the three time intervals.

Over the three years considered, 798 event reports were submitted and reviewed. The reporting rate (number of reported events per patient simulated) decreased over time: pre-COVID 0.18 [335/1834]; during-COVID 0.15 [245/1609]; and COVID-adapted 0.13 [218/1695]. The severity of events declined over time (p=<0.001). As time progressed, the location of event origin shifted towards earlier steps in our workflows (i.e. towards simulation-related imaging and treatment planning). Similarly, the point of event discovery shifted to earlier steps as well (ie. towards during pretreatment review and verification, and away from treatment delivery and management). Communication was frequently identified as a contributor during the latter two time periods while workload was less frequently cited compared to pre-COVID.

The severity, site of origin/discovery of events and associated/contributing factors varied over time demonstrating shifts in the nature of events associated with changes in pandemic-induced workflows. Additional efforts to promote event reporting are needed to maintain the benefits of incident learning.