Embarking on the path toward ASTRO’s APEx – Accreditation Program for Excellence® is a transformative endeavor for any radiation oncology practice. This rigorous process sets a high standard for quality and safety in patient care. In this blog, we have the privilege of hearing from five members of the radiation oncology community who have successfully achieved APEx accreditation or are in the process of doing so. Their experiences shed light on how they learned about APEx, the pivotal factors that led to their decision to change accrediting bodies, and the challenges and triumphs encountered. Additionally, we gain insight into the unique aspects of APEx that set it apart from their previous accreditation experiences, like the Self-Assessment. Their collective experiences offer a roadmap for other practices that may be considering APEx. For more detailed information about each phase of the APEx process, visit About APEx.
About your decision to switch:
Douglas Prah, PhD: Was there a specific tipping point or deciding factor in changing accreditation programs?
Colleen A. F. Lawton, MD, FASTRO: I was involved in ASTRO leadership and wanted to be part of this critical initiative as soon as possible. We were ACR accredited since it began and highly value the accreditation process. The APEx process was more involved than ACR and thus we wanted to have this new level of accreditation that was Safety is No Accident based. So as soon as our ACR Accreditation was expiring we just changed to APEx.
Virginia Lockamy, PhD: Since our practice is in New Jersey, we had to wait for the state to recognize APEx before switching our accrediting body. [APEx has been accepted in all 50 states since 2021.]
Jennifer Tietz, RT(T) and Kileigh Peturis, MS: Participation in the RO-ILS program, excellent publications such as Safety is No Accident, and professional recommendations drove the switch. The radiation safety emphasis and APEx Standards were also factors.
Chris Channels, RT(T): In the last three cycles, ACR would approve us “conditionally,” creating much more work for us. It was almost as if that was their standard operating procedure, as we have always felt we do things correctly. We looked at other options, and APEx was very attractive to us.
Prah: Were there any key advocates for switching? What were the reasons voiced by your practice staff for or against changing accreditation programs?
Tietz/Peturis: At the beginning of the process, there was apprehension about switching programs because the current agency was known, and we had built a solid relationship with the organization. In hearing from colleagues across the [Texas Oncology] network, APEx was comprehensive, patient-focused and streamlined with less administrative burden during the initial application process.
Channels: Our Medical Director and Radiation Director were the key advocates for switching programs. We wanted to make a change for two reasons. First, ACR kept giving us “conditional” approvals each cycle, so we decided to look at other options. Second, being under the ASTRO umbrella, we knew that APEx would be radiation oncology-focused, whereas ACR has a much broader scope. In addition, APEx’s attention to safety and quality attracted us, as that is our focus at HOA. It also allowed us to deeply dive into all our policies and procedures to update and improve upon what we were already doing. The guidance provided by APEx made this an easy process overall.
Lockamy: Fortunately, we had buy-in from the entire team. As a current APEx Surveyor, I was able to explain the benefits of the program and answer any questions/concerns. Our partners at Penn Medicine were also supportive of our switch to APEx as they are currently accredited by APEx as well. We felt that this program was more robust and more specific to radiation oncology as it was developed by ASTRO.
APEx Process — Team and Timing:
Prah: Who was involved in the actual APEx process? How was the work managed at your practice?
Tietz/Peturis: The Director of Radiation Services, Regional Chief Physicist and Chief Radiation Therapists were involved in completing the Self-Assessment. Monthly meetings are hosted. All electronic documentation is saved on SharePoint, and general information is shared via MS Teams.
Lawton: Physics, dosimetry, therapists, department managers and radiation oncologists. Initially, we had weekly meetings. Once we got accredited, roughly monthly.
Channels: Chief Physicist, Chief Radiation Therapist, Lead RTT and myself. Monthly meetings started about six months before our facility visit.
Lockamy: Our Assistant Vice President of Radiation Oncology, Director of Physics, Medical Director, two site managers, and one site supervisor were all part of the APEx Self-Assessment. We also enlisted a few therapists to assist with the chart review preparation. We met weekly to review our progress. We tracked our work in a spreadsheet and assigned owners to each section of the Self-Assessment.
Prah: How long did the Self-Assessment take? Was that more or less than your expectations? Why?
Lockamy: The Self-Assessment took us three months to complete. This also included the medical record review preparation. The Medical Record Review [of the Self-Assessment] took the longest for us to complete, which was longer than we expected. The reason is that it was a more thorough and comprehensive review of the charts than required by our previous accrediting body.
Lawton: The Self-Assessment took longer than expected as many of our safety procedures were not documented well and needed to be added or updated.
Prah: What are some unique aspects of APEx compared to your previous experience? What changes did you see at your practice?
Lawton: The discussions alone were helpful as we started to document and/or update documents of safety protocols. Once we had our documents done and accreditation obtained, updating the documents for future accreditation was much easier.
Lockamy: The entire process, from preparation to on-site facility visit, was more robust than our previous experiences. We implemented multiple changes to our practice in response to our preparation for the survey. For instance, our physicians were not always documenting pertinent negatives during their consults. We also reviewed our existing policies and procedures. Based on the guidelines provided by APEx, we revised multiple ones and developed new ones we lacked.
Prah: Were there any unexpected challenges in the transition process? If so, what?
Channels: At first, applying for accreditation seemed daunting, but APEx makes the process seamless, and the ASTRO staff support was excellent. Any questions we had were answered in a timely manner, which helped us to keep moving forward. We were unsure how the Self-Assessment document upload would be reviewed. We kind of took the approach of “here is what we have” and submitted it. We did not pass the first time, but we refocused our efforts so that we could successfully complete that step of the process.
Lawton: The biggest challenge was the time needed to do the initial work for the first APEx Accreditation. Having ACR Accreditation, we thought, would make this initial work for APEx easy, but that was wrong. APEx is much more detailed and totally worth the effort.
Prah: How was your experience with APEx Surveyors and the facility visit?
Channels: Our experience with the [APEx] surveyors and facility visit was excellent. The surveyors did not seem to be looking for things that were wrong; they were more interested in how and why we did things at our facilities. We felt they were working with us instead of dissecting every little thing.
Prah: What was identified as a low-performing area during the Self-Assessment? How has your practice addressed that before or after the facility visit? Was there any unexpected feedback from the Self-Assessment or facility visit?
Lawton: A significant area of improvement was written documentation. This was especially true for our standing committees that performed valuable functions for our department, but whose function and operation were never explicitly documented. We mandated that committee charters be drafted, including a purview, scope, membership guidelines, quorum guidelines, procedural and operational format, and standing agenda outline. We renamed our Safety Committee to the Patient Safety and Quality Committee, including our Comprehensive Quality Management Program. We also formalized our Service and Technology and Implementation and Review Committee. The formalization also encouraged better communication within the greater department and more thorough documentation of meetings. Another significant improvement was the standardization of documentation across the practice within the medical record for consults and follow-up notes, as well as improving our written planning directive. The good news is that once the Self-Assessment is done, your site will have an excellent idea of your ability to get APEx accredited or what you need to do to improve.
Lockamy: We knew going into both the Self-Assessment and on-site facility visit that we were going to be marked as low-performing on the documented patient-specific planning directive. Our physicians were alerting our dosimetrists to what dose constraints they wanted but not in a formalized document. We had templates built and implemented by the facility visit to demonstrate to the surveyors.
Prah: How was the customer service from ASTRO?
Channels: Overall, the experience was great. The material on the APEx website was very detailed and helped guide us through the process.
Lockamy: We had a few questions throughout the process and were able to reach out to APExSupport to have them addressed, whether through email or a meeting.
Tietz/Peturis: Thus far, the customer service has been prompt and professional, and has provided clear instructions for all inquiries.
Are you interested in transitioning to APEx from another radiation oncology accrediting body? Schedule a free one-on-one session with ASTRO staff to discover how APEx can benefit your practice. During the call, ASTRO staff will provide information tailored to your practice’s needs and goals. You can also request a teleconference with a knowledgeable radiation oncology professional from your chosen discipline by completing the peer-to-peer request form. This meeting will allow you to hear from your colleagues who have completed the APEx process. You can ask specific questions and learn from their experiences.
Interviewer:
 Douglas Prah, PhD
APEx Surveyor, ASTRO Practice Accreditation Subcommittee Member |
Interviewees:
 Chris Channels, RT(T)
Past Accreditation: ACR (2013-2022) |
 Colleen A. F. Lawton, MD, FASTRO
Past Accreditation: ACR (1995-2018) |
 Virginia Lockamy, PhD
APEx Surveyor since 2019 |
 Jennifer Tietz, RT(T)
Past Accreditation: ACRO (2017-2023) |
 Kileigh Peturis, MS
Past Accreditation: ACRO (2017-2023) |
