A Quality Improvement Project: The Implementation of an Electronic Checklist to Improve Patient Safety and Timeliness of Surveillance Imaging for Radioembolization Patients

Problem and purpose: Liver cancer patients are a complex patient population, and the treatment of choice is radioembolization with Yttrium-90 treatment, when surgery is not suitable. It was identified that the current workflow flow process to coordinate a treatment was inefficient and fragmented due to the use of a paper-based approach. This process caused omissions that resulted in delays of treatment and delays in surveillance imaging in post-radioembolization treatments. The purpose of this project is to implement an electronic checklist to improve patient safety and timeliness of obtaining surveillance imaging in liver cancer patients who have undergone a radioembolization treatment.

Evidence/background: The literature reveals that it is critical to have close follow-up and timely surveillance in post-radioembolization treatments. Surveillance imaging is used to determine tumor response and detect new lesions. A radioembolization treatment can lead to progression free survival and result in successful downstaging of tumor. It can also prepare a patient for liver transplant candidacy.

Methods: An electronic checklist was developed within the existing electronic health record for patients undergoing a radioembolization treatment in the interventional radiology department. Patients diagnosed with liver cancer and candidates for a radioembolization treatment were reviewed for six months to determine the number of patients who did not have any omissions in the pre-radioembolization evaluation and number of patients that obtained a timely surveillance imaging post-radioembolization. The plan-do-study-act cycle was performed to monitor the progress of the electronic checklist.

Results: The use of the electronic checklist resulted in three omissions in the pre-radioembolization treatment phase. Out of the 24 patients who were referred for a radioembolization consultation, six patients underwent a radioembolization within the 6-month time frame. The data revealed that 66% obtained timely surveillance imaging studies post-radioembolization treatment.

Conclusion: The implementation of the electronic checklist showed overall improvement in patient safety and streamlining the workflow process. Continued success of this quality improvement project will warrant an agreed upon policy by the interventional radiologists and medical oncologists with specific surveillance imaging guidelines.