Peer Review to Improve Patient Safety

CHAPEL HILL, NC - Earlier this year, reports in The New York Times and other media outlets have highlighted the issue of radiation safety in the medical setting, particularly in the practice of radiation oncology.

The media attention brought additional relevance to a study by UNC radiation oncology faculty members and UNC Lineberger members Larry Marks, MD, and Robert Adams, EdD. The results of their study on peer review in radiation oncology clinical practice were presented at the American society for Radiation Oncology (ASTRO) meeting in November 2009. After Dr. Tim Williams, president of ASTRO, spoke in front of Congress on February 26, 2010, ASTRO released a self-assessment module (SAM) dedicated to peer review and the content of the Marks and Adams lecture to an international audience.

Peer review is an old idea in the sciences, but is not always as widely embraced in the traditionally hierarchial practice of medicine. Defined as, “the evaluation of creative work or performance by other people in the same field to enhance the quality of work or the performance of the field,” the point of peer review is to find errors in work or performance-since a larger and more diverse group of people will usually be able to make a better evaluation than the person doing the work.

Peer review has been widely used in radiation oncology for many decades. Indeed, the Department of Radiation Oncology at UNC has a very extensive peer review process, which led Marks and Adams to begin to quantify the impact of the department’s peer review activities on patient care. Peer review is logical in radiation oncology because it relies on complex systems. “Providing safe and effective radiation therapy to a cancer patient relies on a team of radiation therapists, medical dosimetrists, medical physicists, and physicians,” says Adams, who serves as program director for UNC’s radiation therapy and medical dosimetry training programs. “It can be complex, and preventing communication breakdowns is key to providing the best patient care. We not only designed metrics to measure physician peer review, we also began to discuss nationally how peer review systems can be better designed for both radiation therapists and medical dosimetrists.”

The team is now conducting research to help determine how human behavior interacts with the systems that are part of the treatment process, and how hierarchial healthcare system and training experiences can affect the willingness of these professionals to speak up to promote patient safety. The initial findings are to be presented at ASTRO’s upcoming meeting in November. “People are very interested to see what we are finding and what we are doing in our patient programs here at UNC to ensure that all of our radiation oncology professionals are advocates for the patients,” said Adams.