自愿同行评审作为重症监护病房质量改进的创新工具——德国重症监护病房的一项回顾性描述性队列研究
Voluntary peer review as innovative tool for quality improvement in the intensive care unit--a retrospective descriptive cohort study in German intensive care units.
作者信息
Kumpf Oliver, Bloos Frank, Bause Hanswerner, Brinkmann Alexander, Deja Maria, Marx Gernot, Kaltwasser Arnold, Dubb Rolf, Muhl Elke, Greim Clemens-A, Weiler Norbert, Chop Ines, Jonitz Günther, Schaefer Henning, Felsenstein Matthias, Liebeskind Ursula, Leffmann Carsten, Jungbluth Annemarie, Waydhas Christian, Pronovost Peter, Spies Claudia, Braun Jan-Peter
机构信息
Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
出版信息
Ger Med Sci. 2014 Dec 15;12:Doc17. doi: 10.3205/000202. eCollection 2014.
INTRODUCTION
Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports.
METHODS
Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs - representing over 300 patient beds - had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented.
RESULTS
External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.
引言
重症监护中的质量改进和安全是快速发展的主题。然而，目前尚无评估重症监护医学质量改进的金标准。2007年，德国重症监护病房（ICU）开展了一个试点项目，开始将自愿同行评审作为质量评估和改进的创新工具。我们描述了自愿同行评审的方法，并通过评估匿名同行评审报告来评估其可行性，分析这些报告中突出的主题集群。
方法
对22份匿名同行评审报告进行回顾性数据分析。所有代表300多张病床的ICU都接受了自愿同行评审。数据从评审团队的同行报告和受访ICU的代表报告中获取。分析了所涉及主题的数量和评估问卷的结果。展示了这些ICU的优势、劣势、机会和威胁报告（SWOT报告）。
结果
对结构、过程和结果指标的外部评估显示，对预定义质量目标的遵守率很高。在SWOT报告中，确定了11个代表普通ICU的主要主题集群。58.1%的提及主题涵盖人员问题、团队和沟通问题以及组织和治疗标准。在问题记录/报告、卫生和伦理方面观察到最常被提及的弱点。我们确定了ICU质量方面的几种独特模式，其中长期人员问题和缺乏良好的报告方法最为有趣。结论：自愿同行评审可以作为一种可行且有价值的质量改进工具确立下来。与质量指标测量等其他方法相比，同行报告更详细地涉及了重症监护医学中共同感兴趣的领域。
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