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Purpose: Interest in incident learning systems (ILS) for improving safety and quality in radiation oncology is growing, as evidenced by the upcoming release of the national ILS. However, an institution implementing such a system would benefit from quantitative metrics to evaluate performance and impact. We developed metrics to measure volume of reporting, severity of reported incidents, and changes in staff attitudes over time from implementation of our institutional ILS. Methods: We analyzed 2023 incidents from our departmental ILS from 2/2012–2/2014. Incidents were prospectively assigned a near-miss severity index (NMSI) at multidisciplinary review to evaluate the potential for error ranging from 0 to 4 (no harm to critical). Total incidents reported, unique users reporting, and average NMSI were evaluated over time. Additionally, departmental safety attitudes were assessed through a 26 point survey adapted from the AHRQ Hospital Survey on Patient Safety Culture before, 12 months, and 24 months after implementation of the incident learning system. Results: Participation in the ILS increased as demonstrated by total reports (approximately 2.12 additional reports/month) and unique users reporting (0.51 additional users reporting/month). Also, the average NMSI of reports trended lower over time, significantly decreasing after 12 months of reporting (p

Purpose: A significant portion of patients undergoing radiation experience a change in the treatment plan during the treatment course for a variety of reasons, including adaptive planning due to tumor response and change in fractionation due to patient clinical status. This study tests whether mid‐course changes to treatment plans increase risk of errors through the use of a large institutional near‐miss incident reporting system. Methods: We analyzed incidents from a departmental near‐miss incident reporting system launched in 2/2012. All incidents were prospectively reviewed weekly by a multi‐disciplinary team including physicians, therapists, dosimetrists, physicists, nurses, and administrative staff. Incidents were assigned a near‐miss severity score ranging from 0 to 4 (no impact/mild/moderate/severe/critical), reflecting the potential harm of the incident if it had reached the patient. Monthly root‐case‐analysis is performed on incidents with the highest severity. Incidents related to change‐in‐plan were flagged, and severity score for these were compared to other incidents via t‐test. Results: From 2/2012 through 12/2012, 662 incidents were submitted through the departmental near‐miss incident reporting system. On multi‐disciplinary review, 59(9%) incidents were directly attributable to a change‐in‐plan. Average severity score for the 59 change‐in‐plan incidents was 1.9, significantly higher than score of 1.5 for other incidents not related to change‐in‐plan (p=0.02). Three(5%) near‐miss incidents were assigned the highest severity score of 4, with issues including: wrong isocenter, wrong fields assigned to new plan, and wrong information in new treatment plan due to existing plan. Conclusion: Changes in treatment plan are sometimes required to provide highest quality of care for patients receiving radiation. Although near‐miss incidents related to change‐in‐plan are relatively uncommon, when they do occur they are more severe than other types of incidents that are observed in the course of clinical operations. Development is underway for new safety process specifically tailored to this identified high‐risk patient group.