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Application of Lean Principles to Improve High-Precision Radiation Treatment Process and Patient Experience in a High-Volume Cancer Center
E404
International Journal of Radiation Oncology Biology Physics
multivariable regression, high-dose SRS was associated with cost reduction (b Z -0.50, p<0.01), yielding an approximate $192 savings per month. Conclusion: Value-based healthcare necessitates increased quality at reduced cost. Trigeminal neuralgia represents an enormous burden upon quality of life, but may require years of care and expensive interventions. SRS dose-escalation appears to offer superior efficacy at a substantially reduced cost. Author Disclosure: J.A. Miller: None. R. Kotecha: None. G.H. Barnett: None. E.S. Murphy: None. C.A. Reddy: None. J.H. Suh: Research Grant; Varian Medical Systems. Travel Expenses; Elekta. G. Neyman: Consultant; Elekta. A. Machado: Consultant; Functional Neuromodulation and Spinal Modulation. Stock; Autonomic Technologies, Cardionomics, Enspire. S. Nagel: None. S. Modugula: None. S.T. Chao: Consultant; Varian Medical Systems.
Hospital, Hyderabad, India, 3Yashoda Hospitals, Hyderabad, India, 4 Continental Hospitals, Hyderabad, India, 5AIIMS, New Delhi, India, 6 Chitranjan National Cancer Institute, Kolkata, India, 7Bundelkhand Medical College, Sagar, India, 8KIMS, Hyderabad, India, 9NSCB Medical College, Jabalpur, India
2994 Evaluation of the Prevalence of Burnout and Psychological Morbidity Among Japanese Radiation Oncologists Practicing in Kyoto University Hospital and Affiliated Institutions A.W. Mampuya,1 Y. Matsuo,1 A. Nakamura,2 and M. Hiraoka1; 1 Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan, 2Massachusetts General Hospital, Harvard Medical School, Boston, MA Purpose/Objective(s): The aims of this study were to evaluate the selfreported prevalence of burnout and psychological morbidity among radiation oncologists working in Kyoto University Hospital and affiliated institutions and to identify factors contributing to burnout. Materials/Methods: We mailed an anonymous survey to 125 radiation oncologists and radiation oncology residents listed in the Kyoto University Hospital and affiliated institutions’ Association membership database. The survey included; the demographic data, the Maslach Burnout InventoryHuman Services Survey (MBI-HS) and the 12-item General Health Questionnaire (GHQ-12). Results: There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, 3 participants (3.4%) fulfilled the MBIHSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low personal accomplishment (PA). Twenty-one (24%) reported a high score for either EE or DP meeting the alternative criteria for burnout with 3 among them, having simultaneously high EE and High DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P<0.001 and <0.01 respectively. Having palliative care activities other than radiation therapy and number of patients treated per year were the only factors associated with burnout. Conclusion: This is the first study investigating the prevalence of burnout and depression among radiation oncologist in Japan. Compared to other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double of that of the Japanese general population and was significantly associated with low PA and EE. Author Disclosure: A. Mampuya: None. Y. Matsuo: None. A. Nakamura: None. M. Hiraoka: None.
2995 Application of Lean Principles to Improve High-Precision Radiation Treatment Process and Patient Experience in a High-Volume Cancer Center A.K. Jotwani,1 S. Ravi,2 S.S. Vallinayagam,2 A. Ayyalusamy,3 R.M.V. Reddy, Sr,4 A. Mishra,5 D. Lahiri,6 A.K. Jain,7 K.C.G. Reddy,2 N. J,8 and S. Rawat9; 1Yashoda Hospitals, Hyderabad, India, 2Yashoda
Purpose/Objective(s): Complex radiation treatments like radiosurgery and gated treatments involve multiple complex steps, demand stringent safety protocols, and longer process timings. Lean is a set of $132#management principles that aims at creating maximum value for patient in terms of better quality care and an efficient process to eliminate waste/ wait. In present study, we evaluated application of lean philosophy to the high precision radiation treatment processes. Materials/Methods: Study was carried out in a high volume cancer center. For the purpose of study we recorded process flow times in 2 phases. We recorded times from immobilization to acquisition of images and treatment planning. In second phase, we calculated daily times for patient setup and treatment delivery for 20 patients over 1 week (100 treatment fractions), additionally we recorded daily patient waiting times. The 100 treatment fractions comprised of 45 SBRT/ IGRT treatments with respiratory gating, 42 stereotactic radiation therapy (SRT) fractions and 18 fractions on hypofractionated SRT (HSRT) protocol. We then formed value stream map (VSM) for the process flow and noted time taken for each step including waiting times. For the purpose of study we applied lean principles to the process workflow including standardization of process steps and designing a planning instruction chart to be filled by treating physician. Similarly we grouped patients with similar treatments together like (SRT+HSRT) and (SBRT/IGRT with respiratory gating) to avoid repetition of common baseline steps. We reformed the value steam map for the treatment process with lean applications and recorded process timings. Results: Treatment simulation and planning time could be reduced by 53 minutes with implementation of planning instructions chart, dedicated slot for imaging in CT scan unit could reduce 47 minutes of waiting time, another 120 minutes could be saved with dedicated slot for additional imaging. Clubbing of all similar treatments saved 124 minutes per day on an average for SRT/HSRT (P value <0.005) patients and 92 minutes per day for respiratory gating patients. Theoretically we could reduce average 216 minutes of daily treatment time by application of lean principles. The current daily waiting time noted by patients was average 23 minutes. Theoretically we could reduce daily waiting time to 11 minutes for each patient. On an average for each simulation and treatment course of 25 fractions, the waiting time for each patient could be reduced by 515 minutes. Conclusion: Effective implementation of lean management principles can significantly reduce patient waiting times adding value to the experience. It can also increase daily treatment capacity on a linear accelerator by additional 216 minutes of treatment time. Clubbing similar treatments and standardization of processes can help in effective utilization of resources, improves quality. Author Disclosure: A.K. Jotwani: None. S. Ravi: None. S. Vallinayagam: None. A. Ayyalusamy: None. R.V. Reddy: None. A. Mishra: None. D. Lahiri: None. A.K. Jain: None. K.C. Reddy: None. N. J: None. S. Rawat: None.
2996 Examining Trends in the CMS Medicare Provider Utilization and Payment Database for Radiation Oncologists V. Jairam,1 C.P. Gross,2 and J.B. Yu2,3; 1Yale University School of Medicine, New Haven, CT, 2Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, 3Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
International Journal of Radiation Oncology Biology Physics
multivariable regression, high-dose SRS was associated with cost reduction (b Z -0.50, p<0.01), yielding an approximate $192 savings per month. Conclusion: Value-based healthcare necessitates increased quality at reduced cost. Trigeminal neuralgia represents an enormous burden upon quality of life, but may require years of care and expensive interventions. SRS dose-escalation appears to offer superior efficacy at a substantially reduced cost. Author Disclosure: J.A. Miller: None. R. Kotecha: None. G.H. Barnett: None. E.S. Murphy: None. C.A. Reddy: None. J.H. Suh: Research Grant; Varian Medical Systems. Travel Expenses; Elekta. G. Neyman: Consultant; Elekta. A. Machado: Consultant; Functional Neuromodulation and Spinal Modulation. Stock; Autonomic Technologies, Cardionomics, Enspire. S. Nagel: None. S. Modugula: None. S.T. Chao: Consultant; Varian Medical Systems.
Hospital, Hyderabad, India, 3Yashoda Hospitals, Hyderabad, India, 4 Continental Hospitals, Hyderabad, India, 5AIIMS, New Delhi, India, 6 Chitranjan National Cancer Institute, Kolkata, India, 7Bundelkhand Medical College, Sagar, India, 8KIMS, Hyderabad, India, 9NSCB Medical College, Jabalpur, India
2994 Evaluation of the Prevalence of Burnout and Psychological Morbidity Among Japanese Radiation Oncologists Practicing in Kyoto University Hospital and Affiliated Institutions A.W. Mampuya,1 Y. Matsuo,1 A. Nakamura,2 and M. Hiraoka1; 1 Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan, 2Massachusetts General Hospital, Harvard Medical School, Boston, MA Purpose/Objective(s): The aims of this study were to evaluate the selfreported prevalence of burnout and psychological morbidity among radiation oncologists working in Kyoto University Hospital and affiliated institutions and to identify factors contributing to burnout. Materials/Methods: We mailed an anonymous survey to 125 radiation oncologists and radiation oncology residents listed in the Kyoto University Hospital and affiliated institutions’ Association membership database. The survey included; the demographic data, the Maslach Burnout InventoryHuman Services Survey (MBI-HS) and the 12-item General Health Questionnaire (GHQ-12). Results: There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, 3 participants (3.4%) fulfilled the MBIHSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low personal accomplishment (PA). Twenty-one (24%) reported a high score for either EE or DP meeting the alternative criteria for burnout with 3 among them, having simultaneously high EE and High DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P<0.001 and <0.01 respectively. Having palliative care activities other than radiation therapy and number of patients treated per year were the only factors associated with burnout. Conclusion: This is the first study investigating the prevalence of burnout and depression among radiation oncologist in Japan. Compared to other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double of that of the Japanese general population and was significantly associated with low PA and EE. Author Disclosure: A. Mampuya: None. Y. Matsuo: None. A. Nakamura: None. M. Hiraoka: None.
2995 Application of Lean Principles to Improve High-Precision Radiation Treatment Process and Patient Experience in a High-Volume Cancer Center A.K. Jotwani,1 S. Ravi,2 S.S. Vallinayagam,2 A. Ayyalusamy,3 R.M.V. Reddy, Sr,4 A. Mishra,5 D. Lahiri,6 A.K. Jain,7 K.C.G. Reddy,2 N. J,8 and S. Rawat9; 1Yashoda Hospitals, Hyderabad, India, 2Yashoda
Purpose/Objective(s): Complex radiation treatments like radiosurgery and gated treatments involve multiple complex steps, demand stringent safety protocols, and longer process timings. Lean is a set of $132#management principles that aims at creating maximum value for patient in terms of better quality care and an efficient process to eliminate waste/ wait. In present study, we evaluated application of lean philosophy to the high precision radiation treatment processes. Materials/Methods: Study was carried out in a high volume cancer center. For the purpose of study we recorded process flow times in 2 phases. We recorded times from immobilization to acquisition of images and treatment planning. In second phase, we calculated daily times for patient setup and treatment delivery for 20 patients over 1 week (100 treatment fractions), additionally we recorded daily patient waiting times. The 100 treatment fractions comprised of 45 SBRT/ IGRT treatments with respiratory gating, 42 stereotactic radiation therapy (SRT) fractions and 18 fractions on hypofractionated SRT (HSRT) protocol. We then formed value stream map (VSM) for the process flow and noted time taken for each step including waiting times. For the purpose of study we applied lean principles to the process workflow including standardization of process steps and designing a planning instruction chart to be filled by treating physician. Similarly we grouped patients with similar treatments together like (SRT+HSRT) and (SBRT/IGRT with respiratory gating) to avoid repetition of common baseline steps. We reformed the value steam map for the treatment process with lean applications and recorded process timings. Results: Treatment simulation and planning time could be reduced by 53 minutes with implementation of planning instructions chart, dedicated slot for imaging in CT scan unit could reduce 47 minutes of waiting time, another 120 minutes could be saved with dedicated slot for additional imaging. Clubbing of all similar treatments saved 124 minutes per day on an average for SRT/HSRT (P value <0.005) patients and 92 minutes per day for respiratory gating patients. Theoretically we could reduce average 216 minutes of daily treatment time by application of lean principles. The current daily waiting time noted by patients was average 23 minutes. Theoretically we could reduce daily waiting time to 11 minutes for each patient. On an average for each simulation and treatment course of 25 fractions, the waiting time for each patient could be reduced by 515 minutes. Conclusion: Effective implementation of lean management principles can significantly reduce patient waiting times adding value to the experience. It can also increase daily treatment capacity on a linear accelerator by additional 216 minutes of treatment time. Clubbing similar treatments and standardization of processes can help in effective utilization of resources, improves quality. Author Disclosure: A.K. Jotwani: None. S. Ravi: None. S. Vallinayagam: None. A. Ayyalusamy: None. R.V. Reddy: None. A. Mishra: None. D. Lahiri: None. A.K. Jain: None. K.C. Reddy: None. N. J: None. S. Rawat: None.
2996 Examining Trends in the CMS Medicare Provider Utilization and Payment Database for Radiation Oncologists V. Jairam,1 C.P. Gross,2 and J.B. Yu2,3; 1Yale University School of Medicine, New Haven, CT, 2Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, 3Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT