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

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.

The German quality indicators in intensive care medicine 2013--second edition.

Quality indicators are key elements of quality management. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2010 were recently evaluated when their validity time expired after two years. Overall one indicator was replaced and further three were in part changed. The former indicator I "elevation of head of bed" was replaced by the indicator "Daily multi-professional ward rounds with the documentation of daily therapy goals" and added to the indicator IV "Weaning and other measures to prevent ventilator associated pneumonias (short: Weaning/VAP Bundle)" (VAP = ventilator-associated pneumonia) which aims at the reduction of VAP incidence. The indicator VIII "Documentation of structured relative-/next-of-kin communication" was refined. The indicator X "Direction of the ICU by a specially trained certified intensivist with no other clinical duties in a department" was also updated according to recent study results. These updated quality indicators are part of the Peer Review in intensive care medicine. The next update of the quality indicators is due in 2016.

[The peer review procedure and its place in medicine]. / Übersichtsartikel zum Peer Review Verfahren und seine Einordnung in der Medizin.

Peer Review literally meaning "re-inspection by a peer" is a special form of external evaluation whose roots go back to Ancient Greece and which is widely employed in science to assess manuscripts submitted for publication. In the medical context the Peer Review process is defined as structured critical self-reflection through dialogue with colleagues. Its prime objective is to improve the quality of patient care by identifying potentials for improvement and by deriving an action plan. Amongst other things, this includes medical standards and guidelines, indications and their traceability, the monitoring of the treatment process as well as the interdisciplinary cooperation and teamwork between different professional groups. The Peer Review practice in Germany has received strong impetus from comprehensive hospital operator projects like IQM, the "Initiative Qualitätsmedizin", and the Peer Review practice in intensive care. This practice, which has primarily been developed by practitioners for practitioners of their own accord, offers the chance to integrate medical quality with little bureaucratic effort and direct transfer of knowledge back into daily clinical work. Another important approach to promote peer reviewer qualifications is the curriculum "Medical Peer Review", which has been published by the German Medical Association since 2011. (As supplied by publisher).

[The "Medical Peer Review" curriculum of the German Medical Association]. / Curriculum "Ärztliches Peer Review" der Bundesärztekammer.

Considering the increasing interest in peer review procedures over the past few years, the German Medical Association (Bundesärztekammer) published a curriculum document in 2011 titled "Medical Peer Review". This curriculum has been conceived to offer guidance for establishing this particularly promising voluntary instrument which links medical quality development with professional learning, focusing and promoting communication and knowledge transfer between experts. Therefore the peers' communicative and social competencies play a central role, including respect and appreciation for each other, the ability to create an atmosphere of trust, to reflect one's own role, to focus on concrete solutions and to constructively deal with conflicts, resistance and fear. For these reasons, the practice-oriented curriculum accentuates both the skills of designing, planning and conducting peer reviews and the necessary personal skills such as the techniques of solution-focused communication and conflict management. (As supplied by publisher).