Transcript Peer Review in Endocrinology - (Powerpoint)

Peer Review in
Endocrinology
John S. Bevan
Peer Review Coordinator
Society for Endocrinology
Definition (Van Weedt, 2000)
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Formalized event – explicit pre-determined
procedures & questionnaires – standards for
reports
Information derived from documentation,
observation and verbal
Standards of good quality and best practice to
be used where available
Scope – clinical care process and its
organisational aspects
Experience of other specialities
Thoracic medicine
 Renal medicine
 Cardiology

British Thoracic Society
Aims
 To increase clinical
effectiveness &
improve patient care
 To benefit reviewed
unit
 To benefit reviewers
Ethos
 Voluntary, supportive
& non-confrontational
 But also tough and
thorough
Richard Page & Brian Harrison.
Journal RCP (London), 1995, 29: 319-24
Endocrinology Peer Review
John Wass initiative....
 Setting appropriate Standards for Clinical
Endocrinology
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 British
Thoracic Society
 Clinical Standards Board for Scotland
Clinical Committee consultation on draft
 Ten standards agreed
 First pilot visits
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Ten Standards:
Clinical Endocrine Care
1.
2.
3.
4.
5.
Initial referral &
assessment
Patient focus
Communication
Endocrine function
testing
Interface with
biochemistry
6.
7.
8.
9.
10.
Endocrine imaging
Interface with
endocrine pathology
Links with other
specialities
High-cost endocrine
therapies
Endocrine audit &
databases
Endocrine Standards – example
Assessing the Standards
Endocrine Standards - example
Supporting documents
http://www.endocrinology.org/about/projects/peerreview.html
Planning a Peer Review Visit
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Centre selection
 Basic
model (TH-DGH)
 Tailored model
Reviewer recruitment
 Setting the timelines

Planning a Peer Review Visit

Centre selection
 Basic
model (TH-DGH)
 Tailored model
Reviewer recruitment
 Setting the timelines

2-day Peer
Review Visit
Timelines
Initial planning:
places, people
& dates
Visit timetables
SAQ-out
SAQ-back
-16
-8
-4 -2 0
weeks
Final reports &
feedback
questionnaires
Draft
reports
checked
Draft
reports
+4 +6 +8
Section 12: LOCAL PERCEPTIONS FOR CHANGE
Pre-visit Questionnaire
What are the changes most wanted by the endocrine
unit?
 General information about region
Outpatient & inpatient workloads
How would they like the endocrine unit to be
 Staffing levels
developed?
 Facilities for endocrinology
Does this relate to any of the local NHS priorities for
 Support services: admin, lab,
change?
imaging
 Speciality links
 Audit and research
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What happens during a PRV?
Pre-visit preparation is vital
 Visits to people, places and events
 Recording – using the report form
 Preliminary feedback
 Decisions on report writing & deadlines
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During a visit
there’s a lot to fit in!
What does the Final Report look like?
What happens to the Final Report?
PR – extracting the digit!
Who’s been visited?
•Sheffield-Chesterfield
•Oxford-Reading
•Hull-York
•Glasgow THs
•Manchester-Pennine
•Stoke-Shrewsbury
•Nottingham-Derby
•Bristol-Taunton
•Cambridge-Ipswich
20 hospitals providing
endocrine services
 14 teaching hospitals
 6 district general
hospitals
Who’s done the work?
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James Ahlquist
Steve Atkin *
John Bevan #
John Connell *
Julian Davis *
Mohgah Elsheikh *
Nick Finer #
Stephen Gallacher *
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*
Ashley Grossman
Colin Johnston
Tara Kearney *
Bill Kelly
John Miell
John Newell-Price *
John Wass *
Volunteered after PRV to their centre
# Undertook 2 or more PRVs
So, has it been worth all the effort?
How was it for the reviewed centres?
Was the Review worthwhile for your unit?
Yes – 100%
Did you feel the Report analysed your unit
objectively?
Yes – 100%
Did the Report identify any unanticipated
deficiencies?
Yes – 27%
Do you plan to share the Report with your managers
Yes – 100%
Would you volunteer to be reviewed again?
Yes – 100%
If so, after what period?
3.4 years (2-5)
Having been reviewed, would you volunteer to be a
reviewer?
Yes – 83%
(20-item questionnaire – sent 2 months after visit – 65% RR)
Reviewed consultants said...
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‘I believe the PRV was very important – our MD and
CEO used the report to lobby PCTs whenever they
had a chance’ (DGH)
‘It got us all thinking about what we do’ (TH)
‘Excellent report captured all the current issues within
our department & the city as a whole’ (TH)
‘Many thanks to the reviewers for their supportive
attitude and for stimulating discussion’ (TH)
‘We often feel a bit isolated....so it was reassuring to
learn we’re actually doing quite well!’ (DGH)
How was it for the reviewers?
How many weeks before the visit did you receive
the Self-Assessment Questionnaire?
2.4 weeks (1-6)
Did you find Reviewing a worthwhile experience?
Yes – 100%
Did you pick up any new ideas during the visit?
Yes – 82%
How long did it take you prepare the Report
6.4 hours (3-16)
Would you be a Reviewer again?
Yes – 100%
If so, after what period?
6-12 months
(17-item questionnaire – sent 2 months after visit – 61% RR)
Reviewers said...
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‘I found it very valuable & it led to more reflection
about our own unit’ (TH)
‘Thanks for allowing me to be a Reviewer – I found it
to be an absolutely invaluable & incredibly useful
experience’ (DGH)
‘Excellent development – I benefited from a peer
review visit and was happy to reciprocate for the
Society’ (TH)
‘A beneficial, albeit exhausting, exercise for me!’ (TH)
‘Gave me some good ideas for updating my own
protocols and PILs!’ (TH)
Reviewers ‘pick up’ good ideas!
How well did the endocrine centres do?
‘Essential’ standards (n=30)
120
Percent
84%
100
Met
82%
Exceeded
80
60
40
20
0
A
B
C
D
E
F
G
Teaching hospitals
H
a
b
c
d
DGHs
e
f
How well did the endocrine centres do?
‘Desirable’ standards (n=18)
Percent
80
Met or Exceeded
70
60
50
55%
40
45%
30
20
10
0
A B C D E F G H
Teaching hospitals
a b c d e
DGHs
f
How well did the endocrine centres do?
‘Desirable’ standards (n=18)
Unmet
Percent
60
50
40
25%
32%
30
20
10
0
A
B
C
D
E
F
G
Teaching hospitals
H
a
b
c
d
DGHs
e
f
Types of Recommendation
Total = 128 (71 ‘major’ & 57 ‘minor’)
Simple organisational changes
Additional staff
Service development
Improved facilities
Training improvements
Major service review
Miscellaneous
0
5
10
15 20 25
Number
30
35
Progress on 128 PRV Recommendations
... after a mean interval of 3.4 years (range 1-7) ...100% update!
Achieved
Not achieved but still needed
9 Consultants
5.5 Nurses
2 Secretaries
Not practical or unimportant
Only
4%
No data
0
10
20
Funding constraints on
9 staffing posts & 6
facility improvements
30
40
50
Number
60
70
80
Other benefits of peer review
How does my centre compare to others
in the UK?
Workload
 Waiting times
 Administration
 Imaging access
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Activity comparisons between hospitals
“Out-patients seen per Consultant DPA”
600
C
N
500
C
C
C
N
70+250=320
91+253=344
N
400
C
C
C
N
300
C
N
H
I
Return/PA
New/PA
N
200
100
0
A
B
C
D
E
F
G
Teaching hospitals
J
K
a
b
c
DGHs
d
Some quality indicators
Standard 1: Initial referral & assessment
Some quality indicators
Standard 3: Communication
Some quality indicators
Standard 6: Endocrine imaging
What are the problems?
Agreeing the dates
 Understanding the objectives
 Selecting the centres (especially DGH)
 Recording the data
 Time
 Finance
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Where now…..
in the decade of Revalidation?
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Encourage wider UK roll-out
 Still
voluntary
 Who else can review our specialist
activities and team-working?
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New PRV Coordinator, 2010
 Dr
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Petros Perros, Newcastle
Endocrine nurse involvement?
Workload comparisons?
Quality indicators?
Bench-marking?
Next round of visits...
•Aberdeen-Inverness
•London-K/G/T
•London-H/CC
•Plymouth-Exeter
•Belfast•Cardiff•Leeds-
•Sheffield-Chesterfield
•Oxford-Reading
•Hull-York
•Glasgow
•Manchester-Pennine
•Stoke-Shrewsbury
•Nottingham-Derby
•Bristol-Taunton
•Cambridge-Ipswich
Grateful thanks to ...
• Volunteers: Centres and Reviewers
• Society for Endocrinology supporters
• Clinical Endocrinology Trust