Association of a Disease Site Specific Chart Rounds Format With Peer Review Feedback: A Prospective Study.

Abstract

Peer review of radiation treatment plans (chart rounds) is recommended by professional societies and is widely used, although variation exists in implementation. The aim of this study was to investigate the association of a disease site-specific chart rounds format with the frequency of peer review feedback. At a single academic radiation oncology department with multiple sites of clinical practice, weekly review of new treatment plans transitioned from clinical practice site to disease site-specific chart rounds. Peer review participants were blinded to prospective observational data collection during chart rounds before and after the transition to disease-specific chart rounds. Cross-sectional surveys were also distributed to peer review participants. The association of the chart rounds format with each category of peer review feedback (changes to current plan, changes to future plans, other questions, and resident teaching points) was analyzed using multivariable generalized estimating equation models. Peer review feedback on 1456 total radiation plans from 1273 unique patients was analyzed, including 781 plans before and 675 plans after disease-site chart rounds. After implementation of disease-site chart rounds, the frequency of requested changes increased (5.2% vs 1.4% of plans prior; P < .001). Time spent per case was greater in the disease-specific format (3.36 vs 2.09 minutes prior; P < .001). In multivariable generalized estimating equation models, disease-site chart rounds remained significantly associated with plan changes (adjusted odds ratio, 5.09; 95% confidence interval, 2.22-11.7; P < .001), and there was no change in frequency of teaching points. Most (31/35, 89%) attending physician respondents reported favoring continuing the disease-site format. This blinded, prospective study found that transitioning to disease site-specific chart rounds was associated with increased likelihood of requested changes during peer review without compromising resident education. Implementation of the disease-specific chart rounds format should be considered within multisite radiation oncology departments, while evaluation of effectiveness and acceptability in other settings is warranted.