The Profession A Comprehensive Quality Assurance Program for Personnel and Procedures in Radiation Oncology: Value of Voluntary Error Reporting and Checklists John A. Kalapurakal, MD,* Aleksandar Zafirovski, MBA, RT,* Jeffery Smith, BS,* Paul Fisher, AS, RT,* Vythialingam Sathiaseelan, PhD,* Cynthia Barnard, MBA, MSJS, CPHQ, z Alfred W. Rademaker, PhD, y Nick Rave, MS, x and Bharat B. Mittal, MD* Departments of *Radiation Oncology and y Preventive Medicine, Northwestern University Feinberg School of Medicine, and Departments of z Quality Strategies and x Physicians Services, Northwestern Memorial Hospital, Chicago, Illinois Received Nov 8, 2012, and in revised form Jan 21, 2013. Accepted for publication Feb 2, 2013 Summary This report describes the value of a voluntary error reporting system and the impact of quality assurance measures including check- lists and timeouts on error rates in patients receiving radiation therapy. A total of 256 errors in 139 patients were recorded, and the staff compliance rate for check- lists and timeouts was 97%. These quality assurance measures significantly reduced many categories of errors and eliminated errors related to wrong patient, wrong site, and wrong dose. Purpose: This report describes the value of a voluntary error reporting system and the impact of a series of quality assurance (QA) measures including checklists and timeouts on reported error rates in patients receiving radiation therapy. Methods and Materials: A voluntary error reporting system was instituted with the goal of recording errors, analyzing their clinical impact, and guiding the implementation of targeted QA measures. In response to errors committed in relation to treatment of the wrong patient, wrong treatment site, and wrong dose, a novel initiative involving the use of checklists and timeouts for all staff was implemented. The impact of these and other QA initiatives was analyzed. Results: From 2001 to 2011, a total of 256 errors in 139 patients after 284,810 external radi- ation treatments (0.09% per treatment) were recorded in our voluntary error database. The incidence of errors related to patient/tumor site, treatment planning/data transfer, and patient setup/treatment delivery was 9%, 40.2%, and 50.8%, respectively. The compliance rate for the checklists and timeouts initiative was 97% (P< .001). These and other QA measures re- sulted in a significant reduction in many categories of errors. The introduction of checklists and timeouts has been successful in eliminating errors related to wrong patient, wrong site, and wrong dose. Conclusions: A comprehensive QA program that regularly monitors staff compliance together with a robust voluntary error reporting system can reduce or eliminate errors that could result in serious patient injury. We recommend the adoption of these relatively simple QA initiatives including the use of checklists and timeouts for all staff to improve the safety of patients undergoing radiation therapy in the modern era. Ó 2013 Elsevier Inc. Reprint requests to: John A. Kalapurakal, MD, FACR, Department of Radiation Oncology, Northwestern Memorial Hospital, 251 East Huron St, LC 178, Chicago, IL 60611. Tel: (312) 926-3761; E-mail: j-kalapurakal@ northwestern.edu Conflict of interest: none. AcknowledgmentdThe authors thank the Northwestern Memorial Hospi- tal’s Quality Assurance Committee and all staff members in the Department of Radiation Oncology, including physicians, physicists, dosimetrists, radiation therapists, nurses, and social workers for their important contributions. Int J Radiation Oncol Biol Phys, Vol. 86, No. 2, pp. 241e248, 2013 0360-3016/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ijrobp.2013.02.003 Radiation Oncology International Journal of biology physics www.redjournal.org