1. Peer Review in Anesthesia at BIDMC
Steve Pratt, MD
Chair, Peer Review Committee
Director Quality Improvement
Department of Anesthesia, Critical Care & Pain Management
BIDMC

2. Goals of Peer Review
Demonstrate competence of our staff (not root out bad performers)
Find areas for individual improvement and assist with education
Provided education between staff members
Decrease tension between QA and peer review processes
RARELY identify issues requiring disciplinary action

3. The Process
Departmental peer review committee meets regularly to review reappointment files
Specific data reviewed for each
Ad hoc meeting may be called to deal with specific issues
Complaints
Behavior issues
Serious complications potentially related to competence, professionalism, etc

4. Data for Re-appointment
Total cases: OR, OB, ICU, Pain
Subspecialty: TEE, Acupuncture, Pain procedures
Complications: see below
CME
Complaints/Compliments
Suits
Hospital training: OSHA, Universal protocol, etc
Incident reports being added

5. Other reviews
All staff must participate in crisis simulation every 3 years
Annual review with chief
Academic work
Administrative contribution
Teaching
Evaluations by:
Residents
Division director by staff
Staff by division director
Floor managers

6. Adverse outcomes
Every case has a QA entry REQUIRED to close electronic record
Indicators by division
Most cases “None”
All significant adverse events presented to full department at weekly complication meeting
Structured review by 3 department members (see form)
“Thank You” sent to file for presentation

8. Adverse Events & Peer Review
Raw data on complication rates not tracked
Can’t risk adjust
Unclear of impact that management has on many complications
Complications associated with clinical error are tracked
Most cases not attributed to clinician error
Significant error rates about 1: cases
Few repeat errors or trends
Can identify outliers
Reporting of complications tracked
At least 2/cycle
Compliment those who report more (Reynolds, Cohen)

9. Examples of individual support derived from process
PA catheter placement with cardiac division
Anger management
Adjustment of individual staff call to locations where they are most comfortable

10. Culpability at BIDMC Anesthesia
Intention to do harm
Behavior that knowingly or repeatedly takes unacceptable risks
Knowing or repeated violations of policies, protocols, or accepted standards of care.
Knowing or repeated Failure to meet minimum standards.
Failure to participate in Quality Assurance activities. This includes failure to report adverse events or errors
Repeated errors of the same or similar type, or refusal to take appropriate steps at education when an error is made.

11. Potential future topics
Accuracy of charting derived from AIMS
Response to events as identified by AIMs
Simulation
360o review with surgeons and nurses
Completion of mandatory on-line training. Needs defining
On-line summary of performance and other QA/QI data (adoption of Radiology web system)

12. Questions