Session Item

The potential benefits of clinical audits are multiple and have the overall aim of encouraging continuous quality improvement through the implementation of corrective actions based on the recommendations emitted by the audits. The organisation of these audits have become mandatory in European Member states through the publication of the 2013 European Medical Exposure Directive (Council Directive 2013/59/Euratom) which states that Member States are required to ensure that clinical audits are carried out according to national procedures [1]. In Belgium, this mission was implicitly entrusted to the College for Physicians in Radiation Oncology (“The College”). It was decided to use the existing IAEA QUATRO (Quality Assurance Team for Radiation Oncology) methodology and audit tool in order to carry out peer-reviewed clinical audits of all radiotherapy (RT) departments from 2011 to 2015 included [2]. Following this first cycle of audits, the QUATRO tool was reviewed taking into account the Belgian context, the evolution of standards of care and technology. In addition, certain parts of the QUATRO audits were developed in order to optimize the evaluation of quality management systems. Following this review, the adapted version of QUATRO –called B-QUATRO – has then been used to carry out a second cycle of clinical audits of all RT departments. This started in 2017 and will end beginning of 2023 - the audits having been interrupted due to COVID-19.  The organisation of these clinical audits have led to useful as well as relevant sets of commendations and recommendations that have been shared with the audited radiotherapy departments through audit reports [3].

The success of the implementation of these national clinical audits has been aided by a number of favouring elements such as the pre-existence of the IAEA QUATRO document, the existence of national quality oriented platform composed of radiotherapy professionals (“the College”), a limited number of RT department (n= 24) as well as a limited budget allowing for the reimbursement of costs incurred by the auditors. The existence of a culture of quality, safety and multidisciplinary respect within the RT departments have also played a role in the success of the audits. Certain challenges also need to be taken into account when implementing clinical audits. This includes the need to regularly review the quality criteria stipulated within the auditing tool (BQUATRO) - this in accordance with the evolution of what is considered to be best practice while also taken into account the findings of the previous audits. Another challenge is the reliance of these peer-reviewed audits on professional active RT professionals who need dedicated time and necessary skills to carry out the audits. While keeping in mind that the peer review nature of the audits are of uttermost value leading to comprehensive audits and favouring the willingness of the departments to participate in the audits. Finally, it is also necessary to ensure that radiotherapy specific clinical audits – such as B-QUATRO - remain complimentary to hospital accreditation systems.  



References

[1]    Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. n.d.

[2]    Izewska J, Coffey M, Scalliet P, Zubizarreta E, Santos T, Vouldis I, et al. Improving the quality of radiation oncology : 10 years ’ experience of QUATRO audits in the IAEA Europe Region. Radiotherapy and Oncology 2018;126:183–90. https://doi.org/10.1016/j.radonc.2017.09.011.

[3]    Vaandering A, Lievens Y, PScalliet P. Feasibility and impact of national peer reviewed clinical audits in radiotherapy departments. Radiotherapy and Oncology 2020;144:218–23. https://doi.org/10.1016/j.radonc.2020.01.012.