A Medical Staff Peer Review System in a Public Teaching Hospital—An Internal Quality Improvement Tool

Abstract

Peer review of the quality of care of the medical staff in a healthcare delivery system, properly executed and utilized, can bring about changes that improve the quality and safety of patient care, enhance clinical performance, and augment physician education. Although all healthcare facilities are mandated to conduct peer reviews, the process of how it is conducted, reported, and utilized varies widely. In 2007, our institution, a large public teaching acute care facility, developed and implemented an electronic Medical Staff Peer Review System (MS-PRS) that replaced the existing paper-based system and created a centralized database for all peer review activities. Despite limited resources and mounting known challenges, we have developed and implemented a system that includes 100% mortality reviews, an ongoing random review for reappointment and operative procedures, and morbidity peer reviews. Parallel to the 4-year implementation of the system, we observed a steady, significant downward trend in the medical malpractice claim rate, which can be attributable in part to the implementation of MS-PRS. In this paper, we share our experiences in the development, outcomes, challenges encountered, and lessons learned from MS-PRS and provide our recommendations to similar institutions for the development of such a system.

Opioid Prescribing and Physician Autonomy: A Quality of Care Perspective

“…The answer to these criticisms may lie, however, in making these processes more rigorous and better resourced, in order to deploy their ability to examine individualized physician practices, with careful attention to whether specific prescribing decisions for specific patients have been inappropriate, or even intentionally so. Peer review and quality improvement systems are already powerful tools to ensure quality of patient care and address individual instances of inappropriate provider behavior relating to the prescription of opioids [12,56,83]. Such processes could be improved by ensuring a more dedicated focus on proper opioid prescribing practices, particularly with respect to specialty groups such as surgeons, pain management specialists, and psychiatrists.…”

Morbidity and Mortality Conferences: A Mini Review and Illustrated Application in Veterinary Medicine

“…Similarly, frequency of M&MCs is highly variable, with a monthly interval being a common frequency reported in the literature ( 3 , 7 , 12 , 18 – 20 , 23 – 25 , 28 – 30 , 42 , 43 ).…”

“…A common theme of these reports is the clear structure to the M&MC process, though the degree and extent of standardization varied. Some studies focused on identifying and enacting mechanisms for improvement coupled with continuous monitoring of progress ( 12 , 13 , 20 , 25 , 29 ), while others focused on the care pathway ( 12 , 29 ), standardized presentation, and error analysis ( 12 , 13 ).…”

“…These varied approaches have resulted in a 50% reduction in malpractice claims ( 20 ), improved safety culture and quality of care ( 20 , 25 , 29 , 30 ), and reductions in mortality of up to 40% ( 12 , 13 , 29 ). Data should be collected prospectively before as well as after implemented changes in management to properly establish the relationship between enacted changes and outcome.…”

“…In practice, however, M&MCs are often poorly defined in terms of format, goals, and outcomes ( 7 , 18 , 19 ). Learning from errors through reflection and discussion is essential to improve practice, though where this is done ineffectually, or with the emphasis on assigning blame, M&MCs fail to be productive ( 7 , 13 , 20 ).…”