Risk Informed Workflow and Disease Specific Milestones Ensure Safe Patient Transfer and Treatment between Proton Therapy Centers
Abstract
Purpose
With the number of proton centers increasing, each facing intermittent downtime or need for renovations. Developing optimal approaches to maintain uninterrupted treatment is essential to preserve clinical outcomes. This study outlines key risk factors, workflow, safety checks, and milestones to ensure safe and effective patient transfer and continued treatment between centers.
Methods
Following recent successful experiences of patient transfer with other proton centers to treat their patients during periods of downtime, a multi-institutional team of physicists and dosimetrists was formed to establish workflows and checks for future transfers between institutions via failure-modes-and-effects-analysis (FMEA). A process map illustrating patient acceptance through safe delivery was developed, potential failure modes were identified, and an itemized checklist to confirm the feasibility of patient transfer was generated. The failure modes were scored for severity, occurrence, and detectability, providing risk-priority-numbers (RPN). Mitigation methods of failures with severity>8 and RPN≥150 were discussed, and milestones were recommended based on disease site.
Results
The FMEA and experience with transferred patients highlighted safety protocols and automated verification requirements regarding CT calibration and beam model discrepancies, patient information and immobilization device integrity, and prescription and fractionation accuracy. Forty-one patient transfer workflow-specific failure modes were identified; 9 had severity>8 and 3 had RPN≥150. Milestones presented for safe transfer included patient supporting devices, commissioned devices, chart check considerations, dose verification on the TPS with pre-treatment QA CT, and end-of-treatment factors.
Conclusion
Patient transfer between institutions is feasible with a structured risk-informed workflow. This study demonstrates a practical framework to mitigate high-risk failures and facilitate seamless treatment continuity between different centers without compromising patient safety or treatment quality. The workflow and failures presented can facilitate other institutions to explore patient transfer between centers when necessary.