University of Massachusetts Medical School and UMass Memorial Healthcare, Department of Radiology, Worcester, Massachusetts 01655, USA.
J Am Coll Radiol. 2012 Jun;9(6):430-3.e1. doi: 10.1016/j.jacr.2012.01.015.
The aim of this report is to describe the authors' experience with expanding the routine peer-review process to include misdiagnoses from all sources and the use of focused peer review (FPR) in faculty accountability and management.
A department-wide routine peer review was conducted. Each radiologist was assigned 12 cases per month. In addition, clinically reported errors, missed diagnoses discovered outside the routine peer-review process, were identified. Cases were scored from 1 to 5. The department quality office evaluated cases with scores of 3 and 4 from both sources for further processing with FPR, a multistep continuation of the peer-review process using a tracking document. Once initiated, FPR was processed by seeking comments from the division director and the interpreting radiologist. In some cases, FPR was discontinued before completion. Completed FPR documents were submitted to the department chair for administrative action, ranging from no action to termination. All FPR cases are presented at monthly departmental morbidity and mortality conferences.
Routine peer review was done on 1,646 cases from a total of about 300,000 studies by 31 radiologists. Thirty-five cases from the two sources with scores of 3 and 4 were analyzed, 21 from the routine peer review and 14 clinically reported errors. The quality officer initiated 25 FPRs, rejecting 10 because errors were not considered significant. Further scrutiny lead to dropping 7 of the 12 routine and 2 of the 13 cases with clinically reported error. Sixteen FPRs were completed, 5 (31%) from routine peer review and 11 (69%) from clinically reported errors. For these 16 completed FPRs, management decisions were made by the department chair.
Processing of routine peer-review data together with cases of clinically reported error strengthens the peer-review process. Focused peer review can effectively contribute to the surveillance and management of faculty performance for improved patient care.
本报告旨在描述作者将常规同行评议扩展到包括所有来源的误诊，并将重点同行评议（FPR）用于教师问责制和管理的经验。
进行了一项全部门的常规同行评议。每位放射科医生每月分配 12 例。此外，还确定了常规同行评议过程之外发现的临床报告错误和漏诊。病例评分从 1 到 5 不等。系质量办公室对来自两个来源的评分分别为 3 和 4 的病例进行评估，以便进一步进行 FPR 处理，这是对同行评议过程的多步扩展，使用跟踪文档。一旦启动，FPR 将通过向科室主任和解释放射科医生征求意见进行处理。在某些情况下，FPR 在完成前被停止。完成的 FPR 文件提交给系主任进行行政处理，从无动于衷到终止不等。所有 FPR 病例都在每月的科室发病率和死亡率会议上提出。
31 名放射科医生对总共约 30 万份研究中的 1646 例进行了常规同行评议。对评分分别为 3 和 4 的来自常规同行评议和 14 例临床报告错误的两个来源的 35 例病例进行了分析。质量干事启动了 25 次 FPR，拒绝了 10 次，因为认为这些错误并不重要。进一步审查导致放弃了常规和临床报告错误的病例中的 7 例。完成了 16 次 FPR，其中 5 次（31%）来自常规同行评议，11 次（69%）来自临床报告错误。对于这 16 个完成的 FPR，系主任做出了管理决策。
处理常规同行评议数据以及临床报告错误病例可以增强同行评议过程。重点同行评议可以有效地为教师绩效监测和管理做出贡献，以改善患者护理。
