Session Item

Incident Learning plays an essential role in improving quality and safety in radiation oncology.  National and International Organizations have developed incident reporting and learning systems where institutions can participate and submit cases. Additionally, there has been an increase interest from individual institutions to develop and implement their own systems, which allows them to customize system features to meet their specific needs and clinical processes, as well as giving access to the data more readily. The purpose of an institution-specific Incident Learning Systems (ILS) goes beyond capturing only events that reach the patient, but also near misses, issues and situations that arise from everyday clinical operations. By capturing this information, groups can implement an evidence-based continuous practice improvement framework. The following presentation will provide the methodology and experience of implementing an ILS at a large academic institution across several geographic locations. The presentation will cover different steps starting from pre-implementation work, system design and deployment; continuing incidents reviewing and practice quality improvement processes, as well as a summary of outcomes originating from the ILS. Session participants will have an opportunity to learn key points and areas to think about when implementing their own ILS.