Implementation of a Peer Learning Program Replacing Score-Based Peer Review in a Multispecialty Integrated Practice.

OBJECTIVE: The aim of this study was to compare the efficacy of a peer learning program to score-based peer review in a radiology department. MATERIALS AND METHODS: Our score-based peer review program was transitioned to an open, inclusive, education- and improvement-oriented peer learning program. Program performance was evaluated by learning opportunity submissions, program participation, number of learning opportunity distributions to radiologists, number of practice improvement projects resulting from program, and radiologist survey results before and after interventions. RESULTS: Outcomes for the score-based peer review program compared with those of the peer learning program were as follows. The mean number of radiologists participating monthly increased from 5.0 to 35.2 (p < 0.01); submissions increased from 3.0 discrepancies per month to 36.0 learning opportunities per month (p < 0.01); the mean monthly learning opportunity distributions to radiologists increased from 18 to 352 (p < 0.01); improvement projects performed during the study periods increased from 5 to 61 (p < 0.01); and mean monthly continuing medical education credits earned by radiologists increased from 7.7 to 50.6 (p < 0.01). Radiologists felt peer learning accomplished goals better than did score-based peer review. CONCLUSION: In transitioning our score-based peer review program to a peer learning program, our radiologists identified, discussed, and converted more learning opportunities into practice improvement and perceived peer learning to be of higher value than score-based peer review.

Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings.

The purpose of this study is to investigate the clinical and CT findings in patients with symptomatic colonoscopy-induced splenic rupture, and to assess for common features among this cohort. Multi-center search yielded 11 adults with symptomatic splenic injury related to colonoscopy. Workup included abdominal CT in 10 (91%) cases and abdominal radiography in two patients (one patient had both). Colonoscopy findings, post-procedural course, and CT findings were systematically reviewed. Mean patient age was 62.2 years (range, 51-84 years); 8 (73%) of 11 were female. The majority (64%) of colonoscopies were for screening. No immediate complications were reported at optical colonoscopy; tortuosity/redundancy was noted in five cases. Except for a small (8 mm) polyp in one case and a large (10 mm) polyp in another, the remaining nine patients had either diminutive or no polyps. Only one patient presented with hemodynamic instability during post-colonoscopy recovery; the other ten had a delayed presentation ranging from 8 h to 8 days (mean, 2.1 days). All 11 patients presented with abdominal pain. CT was diagnostic for splenic injury with subcaspular and/or perisplenic hematoma in all ten CT cases. Hemoperitoneum was present in eight, visible splenic laceration in three cases, and splenic artery pseudoaneurysm in one case. Five patients underwent splenectomy (four emergent) and six patients were treated conservatively. Average hospital stay was 5.5 days (range, 3-10 days). Colonoscopy-induced splenic rupture characteristically presents as a delayed and often serious complication. In cases of apparent non-traumatic splenic hematoma or rupture at CT, eliciting a history of recent colonoscopy may identify the etiology.