Implementation of a rapid response system at an isolated radiotherapy facility through simulation training

• Published in: BMJ open quality Vol. 11; no. 1; p. e001578
• Main Authors: Kawamura, Hidemasa, Komatsu, Yasuhiro, Tanaka, Kazumi, Kanamoto, Masafumi, Tobe, Masaru, Usami, Chisato, Hinohara, Hiroshi, Oshima, Kiyohiro, Kitada, Yoko, Tsuda, Kazuhisa, Ogano, Tomoaki, Shimada, Hirofumi, Ohno, Tatsuya
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 01.01.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Automation; Clinical outcomes; Collaboration; Humans; Intensive care; medical emergency team; Nurses; patient safety; Patients; Physicians; Physicists; Quality control; Quality improvement; Quality Improvement Report; Radiation therapy; Response time; Safety management; Simulation; Simulation Training; Transportation of Patients; medical emergency team; patient safety; quality improvement; simulation
• ISSN: 2399-6641; 2399-6641
• DOI: 10.1136/bmjoq-2021-001578

A rapid response system is required in a radiotherapy department for patients experiencing a critical event when access to an emergency department is poor due to geographic location and the patient is immobilised with a fixation device. We, therefore, rebuilt the response system and tested it through onsite simulations. A multidisciplinary core group was created and onsite simulations were conducted using a Plan-Do-Study-Act cycle. We identified the important characteristics of our facility, including its distance from the emergency department; the presence of many staff with little direct contact with patients; the treatment room environment and patient fixation with radiotherapy equipment. We also examined processes in each phase of the emergency response: detecting an emergency, calling the medical emergency team (MET), MET transportation to the site and on-site response and patient transportation to the emergency department. The protocol was modified, and equipment was updated. On-site simulations were held with and without explanation of the protocol and training scenario in advance. The time for the MET to arrive at the site during a 2017 simulation prior to the present project was 7 min, whereas the time to arrive after the first simulation session was shortened to 5 min and was then shortened further to 4 min in the second session, despite no prior explanation of the situation. A multidisciplinary project for emergency response with on-site simulations was conducted at an isolated radiation facility. A carefully planned emergency response is important not only in heavy ion therapy facilities but also in other departments and facilities that do not have easy access to hospital emergency departments.