Implementing a verification simulation, or “dry run,” before a scheduled radiotherapy session could minimize possible errors and patient anxiety in the radiology suite, according to recent research out of Pittsburgh.

“Error identification in radiation therapy is critical to maintaining a safe and efficient therapeutic environment,” the corresponding author Steven Gresswell, MD, and colleagues at Allegheny Health Network wrote in Practical Radiation Oncology this month.

“A verification simulation for patient information provides a dedicated time before treatment to duplicate steps of patient setup, imaging and treatment processes as a final quality assurance step," said Gresswell.

Radiology involves a heavy load of intricate technology, Gresswell et al. wrote, but it’s important for staff to mitigate both digital and human errors for quality radiation treatment. The rise of incident learning systems has promoted a culture of transparency, they said, opening the door for non-punitive, voluntary reporting of mistakes.

To determine whether added verification simulation translated to improved safety and quality for patients, the researchers turned to their health system, which implemented a verification simulation across its 11 radiation oncology clinics in 2014.

Troubleshooting the problems 

The team compared success and incident rates after the simulation to already-existing QA measures, like departmental learning systems. The study comprised 965 patients treated in an 18-month period before implementation of the verification simulation and 984 patients treated in the same period with the addition of the dry run.

Surveys were distributed to 211 patients and 55 physicians, nurses and therapists to gauge benefits. Verification simulation was typically scheduled the day before a patient’s first fraction of radiotherapy, the authors wrote and walked that patient through setup, imaging, treatment, and details behind the process without actual delivery of any radiation. 

“The session is designed to allow staff time to verify that the parameters of treatment are accurate and troubleshoot problems in an organized team approach,” Gresswell and co-authors said.

A sum of 28 incidents was ultimately reported in the non-simulation group, according to the study, compared to 18 incidents reported in the verification simulation cohort. In the latter group, more incidents were also detected before the day of treatment, and less on the day of treatment, with a downward trend toward fewer incidents after treatment started.

They also said that unexpectedly 83% of patients reported decreased anxiety during treatment as a direct result of the dry run. Also, the process allows for interactive patient feedback, which Gresswell et al. said can allow patients more autonomy over their treatment course.

“The verification simulation is a workflow QA strategy that can help reduce human and mechanical errors,” the researchers wrote. “Dedicating time and resources to a verification simulation promotes a culture of safety and has been shown to improve the patient experience.”