Safety culture in radiation oncology: implementation and impact of a voluntary incident reporting system integrated with risk analysis

Background: A culture of safety in radiation oncology underpins the entire care process and requires incident reporting and recording systems capable of identifying vulnerabilities before they cause patient harm. The aim of this study was to implement a specific, dynamic incident reporting and recording system integrating all healthcare professionals involved in the radiotherapy pathway, ultimately benefiting patients with cancer. Materials and methods: A descriptive observational study was conducted in a radiation oncology department between April 2021 and March 2022. A web-based portal for voluntary incident reporting was implemented, accessible to 97 professionals, who recorded incidents detected at each stage of the radiotherapy process. The analysis was descriptive and oriented towards organisational learning and the establishment of new barriers to reduce incident risk. Results: A total of 151 records were generated during the study period, corresponding to 31 different incident types out of 198 possible items in the system. The most frequent incidents occurred in the early stages of the radiotherapy process, particularly during simulation, localisation, and treatment planning. Incidents during treatment administration were minimal. Following the implementation of new safety barriers, a second risk assessment demonstrated a measurable improvement: high-risk (HR) events decreased from 13% to 9%, moderate-risk (MR) events decreased from 43% to 35%, and low-risk (LR) events increased from 40% to 45%. Conclusions: The system serves as a tool for fostering a shared safety culture among healthcare professionals, encouraging collective identification of errors. It has demonstrated its utility in identifying risks and continuously improving of patient safety in radiation oncology.