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. 2014 Dec 15:12:Doc17.
doi: 10.3205/000202. eCollection 2014.

Voluntary peer review as innovative tool for quality improvement in the intensive care unit--a retrospective descriptive cohort study in German intensive care units

Oliver Kumpf  1 , Frank Bloos  2 , Hanswerner Bause  3 , Alexander Brinkmann  4 , Maria Deja  1 , Gernot Marx  5 , Arnold Kaltwasser  6 , Rolf Dubb  6 , Elke Muhl  7 , Clemens-A Greim  8 , Norbert Weiler  9 , Ines Chop  10 , Günther Jonitz  11 , Henning Schaefer  12 , Matthias Felsenstein  13 , Ursula Liebeskind  14 , Carsten Leffmann  15 , Annemarie Jungbluth  16 , Christian Waydhas  17 , Peter Pronovost  18 , Claudia Spies  1 , Jan-Peter Braun  19 ; NeQuI-Group (Netzwerk Qualität in der Intensivmedizin)
Affiliations

Voluntary peer review as innovative tool for quality improvement in the intensive care unit--a retrospective descriptive cohort study in German intensive care units

Oliver Kumpf et al. Ger Med Sci. .

Abstract
in English, German

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.

Einleitung: Die Verbesserung von Qualität und Sicherheit in der Intensivmedizin gewinnt zunehmend an Bedeutung. Allerdings fehlt ein Goldstandard für die Beurteilung von Qualitätsverbesserung in der Intensivmedizin. Im Jahr 2007 begann ein Pilotprojekt auf deutschen Intensivstationen, das freiwilliges Peer Review als innovatives Instrument zur Qualitätsbewertung und -verbesserung nutzt. Wir beschreiben die Methode des freiwilligen Peer Review und untersuchten ihre Durchführbarkeit. Wir analysierten anonymisierte Peer-Review-Berichte auf die thematischen Schwerpunkte, die in den Berichten hervorgehoben waren. Methode: Retrospektive Datenanalyse von 22 anonymisierten Peer-Review-Berichten. Alle 22 Intensivstationen – mit zusammen mehr als 300 Patientenbetten – hatten sich freiwilligen Peer Reviews unterzogen. Die Daten wurden aus den Berichten der Peer Reviewer und aus den Rückmeldungen der besuchten Intensivstationen gewonnen. Die Daten wurden im Hinblick auf die Anzahl der behandelten Themen und die Ergebnisse der Bewertungsbögen analysiert. Berichte über Stärken, Schwächen, Chancen und Risiken (SWOT-Berichte) dieser Intensivstationen werden vorgestellt. Ergebnisse: Die Bewertung der Struktur, Prozess- und Ergebnisindikatoren zeigte einen hohen Erreichungsgrad der vorgegebenen Qualitätsziele. In den SWOT-Berichten wurden 11 Hauptthemen, die auf allen besuchten Intensivstationen als relevant eingestuft wurden, identifiziert. 58,1% der genannten Themen betrafen Personalfragen, Team- und Kommunikationsfragen sowie Organisation und Behandlungsstandards. Als Schwachstellen wurden die Themen Dokumentation/Reporting, Hygiene und Ethik eingestuft. Fazit: Das freiwillige intensivmedizinische Peer Review stellte sich als einfach anwendbares und wertvolles Instrument für die Qualitätsverbesserung heraus. Die Peer-Review-Berichte behandelten allgemeine Problemschwerpunkte in der Intensivmedizin detaillierter als andere Methoden, wie z.B. die ausschließliche Messung von Qualitätsindikatoren.

Keywords: critical care; patient safety; peer review; quality improvement; quality management.

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Figures

Table 1
Table 1. Planned timetable of ICU peer reviews
Table 2
Table 2. Characteristics of the ICUs that underwent peer review
Table 3
Table 3. Items extracted from SWOT analysis of peer review reports. Descriptive numbers extracted from SWOT reports.
Figure 1
Figure 1. Schematic overview over the peer review process
The upper part of the figure shows the steps necessary for preparation of the visitation (encircled with dashed line) consisting of contact between the representatives, the state chamber of physicians and the group of peers taking part in the review. Further steps consisting of the peer review visitation and the preparation of the report are shown.
Figure 2
Figure 2. Spider chart representing the results of the external assessment questionnaires
Dots represent mean percent of maximally achievable points for one dimension. All units with questionnaires completed (n=18) were evaluated. The questionnaire consisted of 52 questions each of which could reach 1 to 4 points. The percentage of maximally achievable points for each dimension was computed.
Figure 3
Figure 3. Spider chart representing the plus/minus analysis of the SWOT reports
Black triangles represent the sum of positive and negative counts per thematic cluster (range from –40 to +40). Stronger line represents zero. Black letters represent high values (above +20). Grey letters represent medium level values (+10 to +20). Grey letters in boxes represent low (0 to +10) and black letters in boxes negative values. The plus/minus analysis was extracted from the 22 SWOT reports (strength, weakness, opportunity, threat) evaluated. Every item for each thematic cluster was appointed either “+1” when mentioned in the strength or opportunity part of the SWOT reports or “–1” when mentioned in the weakness or threat part. Numerical values are also presented in Table 3.
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