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At least 19 recordsLinked to original sources
PubMed2001

Manuscript peer review--a guide for health care professionals.

Peer review, in which peer experts assess the value of a manuscript submitted to a professional journal, is regarded as a crucial step in publication. It is generally agreed that its usefulness is highly dependent on the preparedness of each reviewer and quality of each assessment. With sustained growth in biomedical publications, more and more health professionals are being called on to serve as peer reviewers. An instructional framework should assist pharmacists and other health care professionals in conducting high-quality manuscript reviews.

Allied Health Personnel↗
PubMed1998

Exploring the precursors of outcome evaluation in Australia: linking structure, process and outcome by peer review.

Reviews of the structure of the health system and the processes that contributed to them were the main forms of evaluation within nursing in Australia during the 1970s and 1980s. The documentation of the end result of care, or outcome evaluation, was rarely undertaken until more recent times. The development and implementation of formal assessment tools such as Qualpacs, the Phaneuf Nursing Audit, the Rush Medicus Nursing Process Methodology, Monitor, and Senior Monitor indicated the focus on structure and process evaluation. This paper examines how nursing care delivered to patients during the l970s and 1980s was evaluated, and explores why structure and process review were necessary precursors to outcome evaluation in the nineties. The necessity of linking structure and process analysis is discussed, in order to perform effective outcome evaluation to close the feedback loop between quality assessment and quality improvement. Peer review is one mechanism that can be used to achieve this. How this may also be a form of evidence-based practice which results in health gains for patients is also explored.

Australia↗
PubMed1997

Guidelines for internal peer review in the cardiac catheterization laboratory. Laboratory Performance Standards Committee, Society for Cardiac Angiography and Interventions.

The Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions has proposed guidelines for establishing an internal peer review program in the cardiac catheterization laboratory. The first step is to establish a committee and a data base. This data base should include quality indicators that reflect: physician qualifications, outcomes of procedures, and processes of care. The outcomes must be risk-adjusted to account for the variable severity of illness. Data should be collected by catheterization laboratory personnel and entered into a laboratory-specific computerized data base. These data must be analyzed and organized into profiles that reflect the quality of care. Based on this information, the Committee would institute the following interventions to improve physician performance: education, clinical practice standardization, feedback and benchmarking, professional interaction, incentives, decision-support systems, and administrative interventions. The legal aspects of peer review are reviewed briefly.

Cardiac Catheterization↗
PubMedDate not supplied

A peer review program for professional nurses.

Within the past 3 years, the Division of Nursing in a large medical center implemented a career ladder and a professional practice model. Peer review was identified as a critical component for the success of these two initiatives and maturation of the model. Limitations in the conduct of peer review among the professional nursing staff centered around the lack of a coherent process. The Coordinating Council, the governing body of the professional nursing staff, formally recognized the accomplishments of a Quality Improvement team and directed the team to implement and evaluate a process of peer review. The development and implementation of peer review as experienced by this Quality Improvement team is described in this article. The process and structure of peer review and specific continuous improvement tools used by the team in developing this process are reviewed.

Career Mobility↗
PubMed1996

A department of surgery looks at outcomes.

Quality screens for care of surgical patients were selected and implemented in 1993 by a department in a moderate-sized community hospital. The screens were selected so that assessment might be made of all surgical care and that each surgeon annually might know results compared to peers. There were 127 quality screen failures (2.3%) in 5,615 surgical patients. The incidence of wound infection was 0.1%. Twenty-seven of the screen failures (21.3%) were confirmed by peer review. Issues of quality of care in the confirmed screen failures were resolved by letter or morbidity/mortality conference. The approach merits replication.

Humans↗
PubMed1994

The Anaesthetic Services Programme Encompassing Nova Scotia (ASPENS)

A comprehensive peer review programme for anaesthesia departments in Nova Scotia was implemented in 1987 by the anaesthesia community. Departments are reviewed by peers at the request of the Head, Department of Anaesthesia, and the President of the Medical Staff. A confidential report with recommendations is written. Twenty-six reviews have been completed (to June 1993) and have most often documented deficiencies in: design of the anaesthesia record, anaesthesia staff recruitment, inadequate documentation of policies for anaesthesia and post-anaesthesia care, peer review/quality assurance processes, organizational structure of hospital medical staffs and operating room committees, and use of anaesthesia equipment that does not meet current (at date of review) CSA standards. In the four hospitals that have been reviewed twice, 24 of the 30 deficiencies noted on the first review had been corrected before the second review which occurred three to five years later. Nine new deficiencies were noted. Departments are encouraged to request a review every four or five years.

Anesthesia Department, Hospital↗
PubMed2004

Variability in trauma center outcomes for patients with moderate intracranial injury.

BACKGROUND: The variability of outcome between Trauma Centers has not been extensively studied as a possible avenue for performance improvement. Trauma Center variability in severity-adjusted survival for patients with moderate intracranial injury (MII) was studied in order to determine the association of MII-related process of care variables with outcomes. The analytic results were supplemented with peer review of MII patients with unexpected outcomes and identified potential process of care variables. METHODS: A retrospective cohort study was undertaken based on data submitted to a statewide trauma center database from July '95 through June '98. MII patients had one or more selected ICD-9-CM codes with an AIS-90 severity score of 3 or 4 but no higher. Severity adjustment was done using case matching and a logistic function based New Model that appropriately accounts for patients intubated on Emergency Department arrival. MII-related process of care variables derived from the database were identified and their relationship with outcome were evaluated individually and using multivariate methods. Trauma center personnel conducted standardized peer reviews. RESULTS: The study included data from 6765 patients treated at 26 trauma centers. Two centers (2PZW) had significantly more survivors than expected by both severity adjustment methods. Three had significantly fewer survivors than expected (3NZW). By several measures, patients treated in the 2PZW centers were more seriously injured and older than those in the 3NZW centers. CT of the head performed in the treating hospital was the only process of care variable associated with outcome in multivariate evaluations. Peer review also found little association between process of care variables and patient outcomes. However, peer review reported that 23.7% of unexpected deaths identified by case matching or the New Model were preventable or potentially preventable. Peer review also identified as medically unnecessary significant percentages of patients with unexpectedly long stays in hospital (26.4%) or in ICU (17.3%) identified by case matching. Nearly 45% of unexpected complications were judged preventable or potentially preventable. CONCLUSIONS: Two severity adjustment methods identified significant variability in trauma center outcomes for patients with MII. The difference in outcomes between the centers with better than expected (2PZW) and poorer than expected outcomes (3NZW) was substantial. Peer review identified significant opportunities for reducing unexpected deaths, stays in hospital and in ICU, and the occurrence of complications. Trauma registry data and peer reviews found little relationship between available process of care variables and patient outcomes. This study should stimulate discussions to understand reasons for outcome variability and ways to reduce it.

Adult↗
PubMed1997

Benchmarking the quality-monitoring process: a comparison of outcomes analysis by trauma and injury severity score (TRISS) methodology with the peer-review process.

BACKGROUND: One measure of optimal function within a trauma center is the ability to critically examine outcomes from the process of care within the institution, yet guidelines for evaluation of the peer-review process are lacking. This study was conducted to determine the correlation between mortality analysis performed by the peer-review process (PR) within a trauma division and outcome analysis as determined by Trauma and Injury Severity Score (TRISS) methodology. METHODS: The mortality peer-review data for an entire year at our level I trauma center served as the study population. Information was obtained on probability of survival, and a determination of preventability was made using standard, preexisting criteria. Peer review involves assigning each outcome to a specific category through the process of multidisciplinary assessment. Probability of survival data was not used for this purpose. Kappa analysis was performed to determine the degree of agreement in each category and then tested for significance. RESULTS: One hundred four deaths in 1,868 trauma patients (5.5%) were reviewed at our multidisciplinary conference. Outcomes were judged as preventable, potentially preventable, or nonpreventable. Death directly related to exsanguination was typically categorized as potentially preventable. Kappa analysis demonstrated the greatest agreement between PR and TRISS in the nonpreventable category (kappa = 0.213) and the least agreement in the potentially preventable category (kappa = -0.197). Overall, the kappa Z statistic was nonsignificant (Z = 1.24). CONCLUSIONS: Multidisciplinary peer-review outcomes analysis is at least as effective as the computer-generated TRISS probability of survival data for evaluating quality of care in a trauma center and may be more effective for analysis of potentially preventable outcomes.

Adolescent↗
PubMedDate not supplied

Improving clinical performance: a "how to" for procedures review.

As part of comprehensive performance improvement for accredited hospitals, the Joint Commission on Accreditation of Healthcare Organizations requires that institutional data collection include a review of "operative, other invasive, and noninvasive procedures that place patients at risk" (JCAHO, 1998b, p. 125). To meet the standard for comprehensive procedures review, the University Hospitals and Clinics at the University of Mississippi Medical Center developed an innovative methodology to ensure Joint Commission compliance. This article describes the processes used and the outcomes realized by the performance improvement team responsible for procedures review.

Academic Medical Centers↗
PubMed1993

Preparation for hospital accreditation: an efficient and practical approach.

Hospital accreditation has been criticized for its emphasis on structure and documentation. Less attention is given to the clinical process and outcomes of care. How can the accreditation process become a meaningful part of day-to-day hospital management? Four approaches are discussed. (1) The development of industrial type quality assurance programmes that detect negative patient outcomes and improve patient care. (2) The appointment of a Quality Assurance/Accreditation Coordinator with appropriate authority. (3) The establishment of an effective Quality Assurance/Accreditation Committee. (4) The continuous review of accreditation standards through normal committee function and department review, and trial surveys. Such strategies will enable hospital accreditation to develop beyond a paper exercise and to provide the foundation for excellence in health care delivery.

Accreditation↗