OBJECTIVES

A recent goal of Israel's Ministry of Health was to shorten the waiting time for medical procedures. TASMC Radiotherapy Institute identified two indices for improvement:

1. Interval between physician visit to treatment ≤15 calendar days (vt15).
2. Interval between simulation to treatment ≤ 8 calendar days (st8).

METHODS

The study design utilized interventional and retrospective research to examine and to improve compliance with the indices. The research period, January through July, 2017 was compared to the corresponding period of 2016. Data was obtained from hospital databases, patient files and the radiotherapy EMR to calculate workload and plan complexity.

The second phase of the study, January-July, 2018, included treatment planning and approval, and accelerator access in the time-interval evaluations.

RESULTS

A significant improvement, 53% to 63% was observed in the 8 day index, p=0.001. The mean st8 improved from 9.8 to 8.6 days (p=0.0017), however the number of patients simulated in 2017 without treatment increased 27% (22 to 30).

The vt15 increased from 61% to 67%, p=0.04 but the vt15 mean was unchanged (15 days), patient mix was stable, planning complexity was stable per treatment site, and physician workload remained unchanged.

In phase 2, the original indices’ statistics improved further: st8- 71%; vt15- 80% (mean 11 days).

Sub-intervals of vt15 (days): physician visit to simulation, 3.8; simulation to plan approval, 5.01; plan approval to treatment start, 2.42.

CONCLUSIONS

Shortened waiting time for RT in a public healthcare system can be achieved by administrative oversight with frequent reporting. Shared data with physicians creates personal awareness that leads to improvements in the indices. Simulations without treatment seemingly reflect the pressure from management to fulfill the waiting time expectations.

Indices and complexity of planning per disease site can be used as benchmarks for performance evaluation in RT departments.