Chart Rounds question

[Gfunk6]

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Our practice has had a long history of having weekly chart rounds at a single time per week. However, the number/complexity of cases has grown to the point that it is not possible to finish within one hour.

Am curious how non-academic sites handle this. The simplest option would be to extend chart rounds from 60 min to 80-90 min but that would lead to issues attending tumor boards in a timely manner. Another option would be to split up chart rounds by individual site or geographic region.

Thoughts?

 

[medgator]

Streamline the rounds? What are you presenting per pt exactly? We will go through plans on new patient starts unless it's palliative (unless a re-tx or something)

 

[evilbooyaa]

At my institution we do a weekly detailing all of the patients on treatment and whether they are having side effects or not. 99.9% of the time it is not useful. Keep descriptions short and get out of there in the hour.

Unless your set-up is done differently.

 

[Radiator20]

Curious--does anyone have a format for chart rounds they feel is genuinely useful? It just feels like there is an unsolvable tension between (1) presenting enough information to substantively evaluate a case (dx, overall management and (2) keeping it to a reasonable length (unless number of patients is kept very low).

 

[Gfunk6]

We use a remote PC meeting option since we have five different sites that are geographically separated. One Rad Onc MD serves as moderator. Patients which are reviewed are: new starts, new boosts, new adaptive plans, and relevant M&M (e.g. patient hospitalized and treatment discontinued or patient expired). Generally the true new starts take 1-5 minutes each, the rest usually ~ 30 sec.

For each new start, the attending RO MD gives a quick blurb (age, stage, treatment site, fractionation) and we review a plan PDF with axial slices and then review the graphical/tabular DVHs. If no comment then we move on to the next one. One challenge is that we sometimes use chart rounds as a way to convey new, relevant publications/literature. If we have time at the end (very rare nowadays), we can look at 1-2 plans in progress on the TPS if the attending MD has a peer-related question.

 

[BobbyHeenan]

We use a remote PC meeting option since we have five different sites that are geographically separated. One Rad Onc MD serves as moderator. Patients which are reviewed are: new starts, new boosts, new adaptive plans, and relevant M&M (e.g. patient hospitalized and treatment discontinued or patient expired). Generally the true new starts take 1-5 minutes each, the rest usually ~ 30 sec.

For each new start, the attending RO MD gives a quick blurb (age, stage, treatment site, fractionation) and we review a plan PDF with axial slices and then review the graphical/tabular DVHs. If no comment then we move on to the next one. One challenge is that we sometimes use chart rounds as a way to convey new, relevant publications/literature. If we have time at the end (very rare nowadays), we can look at 1-2 plans in progress on the TPS if the attending MD has a peer-related question.

This sounds pretty similar to ours, though we don't often view DVH's for things like palliative treatment, breast tangents, or other simple treatments. We'll take a quick glance at a field and move on.

We too find ours drags on so we try to speed things a long for common low morbidity "run of the mill" treatments.

 

[evilbooyaa]

I never see the value of looking at a DVH during a chart rounds style eval. Is a quick glance at a DVH going to ever show you something noteworthy? Obviously it's important for plan evaluation prior to approval, but is it really QA to look at it for < 5 seconds with all 15 structures on there simultaneously?

 

[medgator]

I never see the value of looking at a DVH during a chart rounds style eval. Is a quick glance at a DVH going to ever show you something noteworthy? Obviously it's important for plan evaluation prior to approval, but is it really QA to look at it for < 5 seconds with all 15 structures on there simultaneously?

Agree, if anything we just have our "PQR" sheets with the relevant dosimetric values and associated constraints in tabular form. Much quicker than looking at a dvh. We send similar tables in for peer to peer imrt requests