Clinical Peer Review Research Articles

Clinical Nurse Peer Review: A Process That Works for the Nurse and the Organization.

Clinical peer review is a strategy that engages nurses in elevating not only the safety of patients but also their influence on practice. There is little guidance in the literature about how to operationalize peer review in a way that promotes just culture. In a postpandemic era, where nurse engagement and retention are low, this article describes how to implement and measure the impact of clinical peer review on practice trends and empower nurses to influence system-wide change.

Practical Considerations for Obtaining Perioperative Transesophageal Echocardiography Accreditation: Collective Experiences at Early-Adopting Centers

The Intersocietal Accreditation Commission (IAC) is a non-profit accrediting organization committed to ensuring the quality of diagnostic imaging and related procedures. It is comprised of a collaboration of stakeholders, spanning numerous medical professionals and specialties. In a recent initiative, IAC Echocardiography introduced a new accreditation specifically for Perioperative Transesophageal Echocardiography (PTE). This accreditation process is anchored in rigorous clinical peer review to ensure diagnostic quality and report accuracy, thus maintaining high standards of medical care.The authors represent the inaugural four sites to achieve IAC accreditation for PTE who have collaborated to share their experiences in achieving this accreditation. This review endeavors to offer actionable insights and proven solutions to navigate the accreditation journey for others. Mirroring the IAC Standards and Guidelines for PTE accreditation, this review is divided into three pivotal sections: 1) organization of a perioperative echocardiography service, including stakeholder engagement to facilitate the application for accreditation; 2) performance of examinations and reporting; and 3) instituting quality improvement strategies and establishing a robust program.The pursuit of accreditation in PTE is to transcend a mere compliance exercise. It signifies a dedication to excellence, continual growth, and above all to the well-being of patients.

Erosion of Peer Review and Quality Assurance Privilege

This Viewpoint discusses recent legal decisions that may affect how medical peer review and quality assurance are performed.

BPI23-008: Accelerating Adoption of Hypofractionation in Breast Cancer Through Clinical Pathways and Peer Review

BPI23-008: Accelerating Adoption of Hypofractionation in Breast Cancer Through Clinical Pathways and Peer Review

Creating a Peer Review Process for Faculty-Developed Next Generation NCLEX Items.

This article reports the findings from a pilot study of a peer review process used with a group of faculty champions who were writing items for a state-wide initiative to establish a Next Generation NCLEX item teaching test bank. Champions were oriented to the peer review process in a face-to-face session and completed reviews using the Clinical Judgment Item Peer Review Form created for the project. Eighteen faculty from 13 different schools attended the session and completed 55 reviews of 40 cases and 35 stand-alone items. Champions took approximately an hour to complete each case study and related stand-alone item review and give actionable feedback. The peer review process benefits reviewers and authors learning to write Next Generation NCLEX questions. The process used in this project can be replicated by other faculty in their own programs.

Letter to the Editor

I write following my reading with great interest the published article “Physicians and Cognitive Decline: A Challenge for State Medical Boards,” in the Journal of Medical Regulation.1I express my opinion based on my own personal experience as an active practicing physician for 47 years across several states.I agree with the article’s author that “older physicians benefit from their many years of experience and the skills they have developed over decades of practice…,” but feel that the use of the generalization that these physicians “may be at risk of cognitive decline, with job performance deficits…,” may be biased and inaccurate. Such a conclusion could raise concern as not based on significant statistical facts and/or factual finding.We cannot and should not generalize, otherwise our opinions become skewed and invalid.State Medical Boards and Peer Review Boards have their own internal review procedures for checks and balances. They are the regulatory and monitoring authorities overseeing physician performance practices, treatment outcomes, physician patient satisfaction, medical errors, negligence, reporting of patient loss, including outcome of claims litigation.2,3,4Having an outside source beyond internal affairs of State Medical Boards and Peer Review Boards mingle and interfere with their internal and intrinsic procedures, proceedings, legislation, and medical staff by-laws seems like an intrusion by telling assigned medical organizations how to oversee, regulate, and proceed in these matters that are akin to physicians telling state bars how to regulate their member lawyers.2,4,6State Medical Boards do identify, monitor, and pursue physicians who show cognitive decline. These bodies already do a good amount of regulating and overseeing of Quality Assurance, as is the case of the Medical Board of California, following their legal state mandate and ethical obligation to the public and its trust.7Many State Medical Boards and Medical Associations have adopted certain methodology to establish such programs. They also have the wisdom to screen and monitor physicians to establish such programs, and the wisdom to screen and monitor physicians’ late impairment through specific Medical Specialty Tests and comprehensive follow-up tests to best identify any such issues.2,4,6There is no set or agreed upon age when such physicians’ testing program should commence. Due process and its protections are paramount for the process of identifying physician impairment and performance below the standard of care, so that the process can be fair, reasonable, and equitable to all.State medical societies already institute public relations campaigns geared to build support among clinicians and other professional medical organizations, as its relevance also applies to State Medical Boards, who are tasked with regulating and overseeing medical and health care providers as well.5Cognitive decline is not exclusively or only inherent to medical practitioners. It also applies to all in the work force, across the board. The dos and the don’ts are ultimately a matter of due process and the law.Given the current physician shortage crisis we are facing in the US, along with the demographic trends, more primary care providers are likely to be needed to meet the increasing needs of the older population, and the need to avoid forced early retirement of aging, elder physicians in this country.5Ultimately, competence rather than mandatory retirement due to age per se should be the deciding factor regarding whether physicians should be able to continue their practice.4Physicians recognize that they are not alone, and the visible leadership by influential national organizations and accrediting bodies (eg, National Academy of Medicine, American Medical Association, Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, the Joint Commission, American College of Physicians, Accreditation Council for Continuing Medical Education) engaging regulators, payers, and other organizations may provide optimism for meaningful change.Respectfully Submitted,Isaac E. Jakubowicz, MD, MPHBeverly Hills, CAgreatpediatrician@yahoo.com

Better together: Implementation of a patient safety solution committee at an academic cancer center.

325 Background: The Mount Sinai Health System oncology service line initiated a patient safety solution (PSS) committee to comprehensively review reported safety events in order to provide safe and high-quality care. This multi- and interdisciplinary committee creates a safe space to report events that caused harm, near misses and empowers all staff to be part of a just culture of safety. Here we describe the process and report on outcomes. Methods: The committee consists of nurses, advanced practice providers, physicians, pharmacists, social workers, IT analysts, and administrative staff, representing the oncology service line across inpatient and outpatient. Any staff member can enter incident reports that they believe warrant review into a software application. Our quality team reviews all events and then selects cases in which harm or near-harm was involved, for in-depth investigation to be presented at bi-weekly PSS meetings where cases are discussed, root causes are evaluated, and solutions are proposed. For each case, the committee votes on standard of care using the Continuous Quality Improvement (CQI) Classifications tool. Often, smaller workgroups are formed to carry out quality improvement (QI) projects and corrective action plans (CAPs). All case data, including patient demographics, case summaries, outcomes, and ongoing plans are tracked using a custom REDCap survey. A question about the role of bias was added in December 2020 (yes/no/not enough information). Results: From January 2021 until March 2022, a total of 115 events were reviewed with an average of 23 events reviewed each quarter. Sociodemographic information on patients reviewed is in table. 41% of cases involved the inpatient setting. Issues with medication comprised 47% of cases, followed by patient identification (11%) and lack of escalation (10%). The most common CAPs involved education and counselling (47%), development of new policies (22%) and escalation to leadership (8%). In total, we have developed 29 new workflows, policies, and guidelines. Bias was felt to be involved 25% of the time, no bias 5% and not enough information 43% of the time. Conclusions: This process illustrates the importance of a multi- and interdisciplinary and transparent approach to clinical case and peer review to ensure the highest level of care. The outcomes of this committee have led us to optimize current policies, create new policies and procedures, new rounding structures and place a renewed focus on bias and discrimination.[Table: see text]

Clinical Peer Review and Just Culture

Features| September 2022 Clinical Peer Review and Just Culture James J. Lamberg, DO, FASA, CPPS James J. Lamberg, DO, FASA, CPPS Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor September 2022, Vol. 86, 22–24. https://doi.org/10.1097/01.ASM.0000874244.68562.22 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation James J. Lamberg; Clinical Peer Review and Just Culture. ASA Monitor 2022; 86:22–24 doi: https://doi.org/10.1097/01.ASM.0000874244.68562.22 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: just culture Clinical peer review is the process whereby medical providers evaluate the quality of their colleagues' clinical work (World J Gastroenterol 2014;20:6357-63). It may also be referred to as medical peer review, quality review, patient safety review, or simply peer review. Clinical peer review focuses on patient care and is separate from issues surrounding professionalism or aberrant behavior. These types of nonclinical issues are generally handled by the department chair and vice chair using the organization bylaws as a guide. Ultimately, the medical executive committee or similar committee is responsible for enforcing the bylaws. Clinical patient care concerns should be handled through a designated peer review committee. “The common initial reaction when an error occurs is to find and blame someone” (asamonitor.pub/3Ob3mML). The concept of “Just Culture” directly opposes the outdated blame-and-shame model of patient safety. The goal is fair and balanced accountability. After a safety event... You do not currently have access to this content.

Pharmacy Practice Standards for Outpatient Nephrology Settings

Patients with kidney disease represent a medically complex group of patients with high medication burdens that could benefit from clinical pharmacy services as part of the interdisciplinary care team to optimize medication use. The “Advancing American Kidney Health” executive order includes new value-based reimbursement models to be tested by the Center for Medicare and Medicaid Innovation beginning January 2021 and January 2022. Advancing American Kidney Health executive order poses opportunities for the inclusion of comprehensive medication management. Following an iterative process integrating input from a diverse expert panel, published standards, clinical practice guidelines, peer review, and stakeholder feedback, our group developed practice standards for pharmacists caring for patients with kidney disease in health care settings. The standards focus on activities that are part of direct patient care and also include activities related to public health and advocacy, population health, leadership and management, and teaching, education and dissemination of knowledge. These standards are intended to be used by a variety of professionals, from pharmacists starting new practices to practice managers looking to add a pharmacist to the clinical team, to create standardization in services provided.

Does authors’ biodata in clinical trials registry affect blind peer review process? For the consideration of medical journal editors

The clinical trial registry is an important platform to register clinical trials to be conducted, along with all the related information of the study, the institutions involved and the details about the authors. In the author’s opinion, this disclosure of information can effect the blind peer review process. Although medical journal editors try best to evaluate all related information, relationships and conflicts, but the disclosure in trials registry can effect the double-blind review process. This can also effect the reviewer’s decsion and can be a source of bias. The authors of medical journals should consider this to further keep the review process transparent and unbiased.
 Key words: Trials registry; Clinical trial; Medical journal; Review; Bias
 Citation: Mahmood T. Does authors’ biodata in clinical trials registry affect blind peer review process? For the consideration of medical journal editors. Anaesth. pain intensive care 2022;26(3):280-282.
 DOI: 10.35975/apic.v26i3.1892
 Received: April 05, 2022, Accepted: May 12, 2022

Is There a Relationship Between Facility Peer Review Findings and Quality in the Veterans Health Administration?

The aim of clinical peer review (PR) is to improve facility health care quality. However, prior authors have shown that PR may be biased, have rater reliability concerns, or be used for punitive reasons. It is important to determine whether facility PR processes are related to objective facility quality of care. We collected proportion of PR findings that "most experienced and competent clinicians may have managed the case differently" or "most experienced and competent clinicians would have managed the case differently" as an objective measure of facility PR processes and outcomes. We correlated these with facility quality metrics for 2019. PR findings were not associated with facility quality metrics but were strongly associated with previous year findings. This study describes a potentially new source of bias in PR and demonstrates that objective facility outcomes are not related to individual PR findings.

Effect of clinical peer review on mortality in patients ventilated for more than 24 hours: a cluster randomised controlled trial

BackgroundAlthough clinical peer review is a well-established instrument for improving quality of care, clinical effectiveness is unclear.MethodsIn a pragmatic cluster randomised controlled trial, we randomly assigned 60 German Initiative Qualitätsmedizin...

Clinical peer Review; A mandatory process with potential inherent bias in desperate need of reform

ABSTRACT Clinical peer review, a process mandated across all hospitals in the USA, originated as a measure to protect patients by ensuring a standardized level of medical service that is provided by all practicing physicians. The process involves retrospective chart reviewing to assess the quality of patients’ care provided by physicians as well as adherence to the most appropriate guidelines. The process of clinical peer review almost entirely serves its ultimate purpose in quality preservation; However, certain laws gave immunity to reviewers resulting in abuse and using the clinical peer review process for secondary gain. Some notable cases of abuse were discussed in the article, we also shed light on two forms of bias that can potentially interfere with the review process and the dreaded outcomes that come along a negative peer review. We also propose methods to overcome these biases to further standardize and improve this crucial process.

Mortality and Morbidity rounds in neonatology: Providers' experiences and perspectives.

To describe how Canadian level III neonatal intensive care units (NICU) organise mortality and morbidity rounds (M&MR) and explore clinicians' perspectives. This questionnaire study, including open-ended questions, examined the following domains: (1) M&MR format, (2) ethical issues and (3) limitations and perceived effectiveness. Sixteen out of twenty (80%) level III NICUs participated. All deaths and 64% of morbidities were discussed. M&MR occurred monthly (69%) with 3-5 patients discussed hourly (63%) and usually (75%) physician led. Wide variations of practice between centres existed for practical issues, such as administrative support and attendance. 44% of centres allowed nurses to participate. Goals reported by participants were also heterogeneous: reducing medical error (56%), educational (50%), improving communication (44%) and peer review (23%). Practical barriers were time (75%) and lack of resources/structure (25%). Four main themes were as follows: the role of M&MR, the ongoing blame culture, communication issues and the distinction between mortality and morbidity. Goals and format of M&MR vary widely. M&MR remains physician-centric, where the blame culture still endures. Neonatal M&MR models should be adapted to the modern NICU to ensure the M&MR stays relevant. It could also benefit from lessons learned in quality improvement.

AMWA-EMWA-ISMPP Joint Position Statement on Medical Publications, Preprints, and Peer Review

The public could lose trust in science if scientific and medical researchers choose to bypass the traditional high standards of peer-reviewed medical journals in the rush to get research data released, particularly during crises such as the COVID-19 pandemic. The statement recognizes the benefit of rapid publication, but alerts against the potential harms associated with an accelerated process. Recommendations are provided for key stakeholders, including a Reviewers’ Checklist to provide a minimum standard of pre-publication vetting to enhance preprint publication processes.

AMWA-EMWA-ISMPP joint position statement on medical publications, preprints, and peer review

AMWA-EMWA-ISMPP joint position statement on medical publications, preprints, and peer review

Resident Peer Review Process: An Innovative Teaching Model in an Internal Medicine Residency Program.

IntroductionMedical peer review is an integral part of the performance improvement process in any hospital. The very first exposure to the peer review process in a physician’s career is typically after graduation and when they start practicing as an attending physician. We implemented a “Resident Peer Review Process” training module in our Internal Medicine residency program with an intention to familiarize the residents about peer review.MethodsThe resident peer review process was implemented over a period of four weeks with the “resident peer review committee” having representation from all three Postgraduate Year (PGY) levels. The committee reviews the cases referred to them over a period of four weeks through a process of weekly meetings and adjudicates the cases. If any deficiency is identified, the committee will provide feedback to the residents involved in the case and presents the educational points identified from the adjudication at the end of the module as a morning report.ResultsEighty-nine (89) cases were reviewed through this process over a span of two years. About 77.5% of the cases were identified to have a deficiency. Teaching points were identified and presented in Week 4 meetings in 80.9% of the cases that had a deficiency. The residents provided a positive response and said that the process improved their quality of patient care (98%), professionalism (95%), systems-based practice, practice-based learning (90%), medical knowledge (88%), and interpersonal and communications skills (87%). DiscussionThis resident-driven, novel, and innovative model can be a successful teaching methodology for Internal Medicine residents to augment Patient Safety and Quality Improvement and could be implemented in residency programs irrespective of the size and specialty.

Proposal of a Standardized Questionnaire to Structure Clinical Peer Reviews of Mortality and Failure of Rescue in Pancreatic Surgery.

Background: Quality management tools such as clinical peer reviews facilitate root cause analysis and may, ultimately, help to reduce surgery-related morbidity and mortality. This study aimed to evaluate the reliability of a standardized questionnaire for clinical peer reviews in pancreatic surgery. Methods: All cases of in-hospital-mortality following pancreatic surgery at two high-volume centers (n = 86) were reviewed by two pancreatic surgeons. A standardized mortality review questionnaire was developed and applied to all cases. In a second step, 20 cases were randomly assigned to an online re-review that was completed by seven pancreatic surgeons. The overall consistency of the results between the peer review and online re-review was determined by Cohen’s kappa (κ). The inter-rater reliability of the online re-review was assessed by Fleiss’ kappa (κ). Results: The clinical peer review showed that 80% of the patient mortality was related to surgery. Post-operative pancreatic fistula (POPF) (36%) followed by post-pancreatectomy hemorrhage (PPH) (22%) were the most common surgical underlying (index) complications leading to in-hospital mortality. Most of the index complications yielded in abdominal sepsis (62%); 60% of the cases exhibited potential of improvement, especially through timely diagnosis and therapy (42%). There was a moderate to substantial strength of agreement between the peer review and the online re-review in regard to the category of death (surgical vs. non-surgical; κ = 0.886), type of surgical index complication (κ = 0.714) as well as surgical and non-surgical index complications (κ = 0.492 and κ = 0.793). Fleiss’ kappa showed a moderate to substantial inter-rater agreement of the online re-review in terms of category of death (κ = 0.724), category of common surgical index complications (κ = 0.455) and surgical index complication (κ = 0.424). Conclusion: The proposed questionnaire to structure clinical peer reviews is a reliable tool for root cause analyses of in-hospital mortality and may help to identify specific options to improve outcomes in pancreatic surgery. However, the reliability of the peer feedback decreases with an increasing specificity of the review questions.

Self-Reported Learning (SRL), a Voluntary Incident Reporting System Experience Within a Large Health Care Organization

In aviation, significant improvements in safety have been attributed to a system of voluntary reporting of errors and hazards by pilots and other frontline personnel. Such a system is lacking in health care. A system to allow physicians to self-report their clinical care errors along with insights to prevent recurrence ("self-reported learning [SRL] system") was established in three hospitals and used for four years in one center and for two years in two others. Clinicians were educated in how to use the system and encouraged to report deviations from standard care by secure e-mail, a telephone hotline, or the institutional incident reporting system. Events were included in the SRL system only if clinicians self-reported them prior to others doing so. Submissions were analyzed for evidence of primary insight, recognition of error, and secondary insight. Physicians were surveyed afterward about their attitudes toward clinical peer review, the physician's role in errors, and the SRL program. There were 117 SRL submissions (less than 5% of clinical peer review cases); 86 had complete information available. Of these, there was agreement among two reviewers that secondary insight was present in 52.2%, and several were novel submissions that otherwise would have not been identified. Survey response rate was 18.3%; 31.1% of respondents had never been involved in clinical peer review before, a majority had an overall favorable impression of clinical peer review, and 47.2% reported not having made "any mistakes worth reporting." An SRL system modeled after the aviation reporting system elicited a low number of reports and did not decrease the number of clinical peer review reports. In a high proportion of SRL reports reporting physicians demonstrated secondary insight. Benefits to SRL reporting could be seen despite low number of self-reports.

Student-led peer review of an online teaching file: perspectives after 2 years

ABSTRACT Problem Opportunities for self-directed learning were missing from our medical school curriculum in general and on our radiology electives specifically. Our objective was to explore the feasibility and benefits of using medical students in the development of our student-created teaching files. Approach In 2018, a website was developed at our institution to support medical student radiology education and create a repository for the online publication of student-developed teaching cases. Students participating in radiology clerkships at our institution had an opportunity to submit case presentations for publication to our online teaching file following peer review. The medical students participated in the peer review process facilitated by the faculty director of radiology undergraduate medical education. The faculty member oversaw the training of new student editors and the development of a peer review guide. Outcomes The peer review guide included goals of the teaching file project and direction regarding the peer review process. Student editors were trained using the peer review guide in conjunction with individual meetings with the faculty mentor. At twenty-four months, 82 student-developed cases had been published to the online teaching file following medical student peer review. The teaching file had garnered 3884 page views. Next Steps The medical student-led peer review process meets core competencies in self-directed learning. The authors plan to explore the application of peer-assisted learning theories to the editing and peer-review process.