From the Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of UPMC.
Emergency Medicine, University of Pittsburgh.
J Patient Saf. 2021 Oct 1;17(7):e689-e693. doi: 10.1097/PTS.0000000000000449.
For academic medical centers to improve quality outcomes, identification and optimization of opportunities for improvement are necessary. Effective clinical peer review frequently has limitations on timeliness, transparency, and consideration of system processes related to untoward clinical outcomes. We developed a process to overcome these barriers and capture opportunities for process improvement identified within the clinical peer review system.
A multidisciplinary committee was formed to evaluate the current process of physician peer review at Magee Womens Hospital of the University of Pittsburgh Medical Center. Evaluation of current peer review triggers, processes, communication, transparency, and actionable outcomes was performed. A new approach was established that incorporated a protected electronic portal to improve communication and provider engagement, as well as initiation of a Just Culture peer review algorithm to realize opportunities for system improvements.
The new process has been operative for 2 years. After initiation, the average time necessary for full case review decreased by 66% (6-2 months). Provider engagement and input have increased to 71%, from less than 10% before implementation. Most cases (51%) were identified as having more than one causative factor, with systems issues being the most frequent contributor to untoward outcomes.
Given the recognized benefits, this approach is being considered for implementation on a broader scale within service-line quality initiatives across the University of Pittsburgh Medical Center health system. Although first implemented among faculty, consideration of incorporation into graduate medical education programs is ongoing.
为了提高学术医疗中心的质量结果，有必要识别和优化改进机会。有效的临床同行评审在及时性、透明度和考虑与不良临床结果相关的系统流程方面经常存在局限性。我们开发了一种克服这些障碍并捕捉临床同行评审系统中发现的流程改进机会的方法。
成立了一个多学科委员会，以评估匹兹堡大学医学中心 Magee 妇女医院目前的医生同行评审流程。对当前的同行评审触发因素、流程、沟通、透明度和可操作的结果进行了评估。建立了一种新的方法，包括一个受保护的电子门户，以改善沟通和提供者的参与度，并启动公正文化同行评审算法，以实现系统改进的机会。
新流程已经运作了两年。启动后，全面审查案件所需的平均时间减少了 66%（从 6 个月减少到 2 个月）。提供者的参与度和投入增加到 71%，而实施前不到 10%。大多数案件（51%）被确定有一个以上的原因，其中系统问题是不良结果的最常见原因。
鉴于公认的好处，正在考虑在整个匹兹堡大学医学中心医疗系统的服务线质量倡议中更广泛地实施这种方法。尽管首先在教职员工中实施，但正在考虑将其纳入研究生医学教育项目。
