FAQ - Peer Reviews
What is an IQM peer review?
The IQM peer review is a voluntary medical process that is original to IQM. It is a quality assurance instrument that focuses on collegial exchange. Clinically active physicians and nursing staff work with their colleagues at the respective clinic to analyse processes and structures for possible improvements based on retrospective records. The core of the IQM review is the collegial case discussion between the peer team and the treatment team at the respective clinic, with both sides on equal footing. The IQM peers are trained according to the “Ärztliches Peer Review” curriculum of the German Medical Association.
What are the objectives of the IQM peer review?
- To analyse processes and structures in case of statistical anomalies in the G-IQIs
- To initiate a continuous improvement process
- To identify areas for improvement and develop proposed solutions
- To learn from each other and help hospitals help themselves
Who are the peers?
IQM peers are chief physicians and nurses who are very familiar with the procedures in a clinic and are recognised experts in their respective fields. They help fellow chief physicians and nurses from other IQM member hospitals to further improve their quality of care.
What are the selection criteria for a peer review?
The selection criteria are defined by the Peer Review steering group on an annual basis. A statistical anomaly (e.g. an SMR above the target value) is an example of a possible criterion.
How do peers prepare for the reviews?
Every IQM peer goes through a 1.5-day training course and then completes two trial reviews. The training follows the “Ärztliches Peer Review” curriculum of the German Medical Association.
- According to which criteria are the treatment procedures analysed?
- Diagnostics adequate and timely?
- Treatment adequate and timely?
- Treatment process scrutinised in an effective and timely manner?
- Was the indication decision for surgery/intervention/intensive therapy appropriate and timely?
- Complication management medically correct?
- General treatment guidelines considered?
- Internal standards applied?
- Documentation complete and conclusive?
- Smooth cooperation among services?
- Treatment progress reviewed by chief/senior physician and review documented?
- Full communication within the department?
- Full communication with nursing staff?
- Next of kin informed in a timely manner?
What percentage of records show room for improvement?
Depending on the indicator examined and the hospital visited, room for improvement is found in 20% to 80% of the records examined.
Which disease syndromes have been examined in peer reviews thus far?
Myocardial infarction, heart failure, heart surgery, stroke, cerebral infarction, pneumonia, COPD, diseases of the large intestine and rectum, gastric surgery, oesophageal and pancreatic interventions, gallbladder removal due to gallstones, kidney removal, urinary bladder interventions, prostate removal, hip fracture, pertrochanteric fracture, hip replacement, ventilation > 24 hours and sepsis.
Who is responsible for selecting the peer reviews?
The Peer Review steering group selects which clinics will be subject to a peer review. The Peer Review expert committee approves the selection.
How are the peer reviews conducted?
During the preparation phase, the clinics/departments are selected based on their quality scores and the clinics are informed. Lists of cases for the records to be analysed are drawn up and an interdisciplinary, inter-professional and cross-operator peer team is put together. The appointment is then set by the team leader in consultation with his or her peer team and the clinic to be visited, which carries out a self-review of the selected records before the peer review.
On the day of the peer review, after a welcome session and introduction of the peers, the record analysis is carried out to assess the quality of treatment. This is followed by a constructive discussion between colleagues of all cases. Finally the medical directors/management board is informed of the results in a closing meeting.
In the follow-up phase, the team leader prepares the peer review minutes with a special focus on the improvement measures discussed and agreed upon, a timetable for implementation and assignment of responsibilities.
What are some typical solutions proposed by the peers to improve quality?
- Review guideline-based diagnostics and therapy
- Review microbiology diagnostics and antibiotic therapy (standards)
- Focus on early detection of complications/sepsis
- Improve interdisciplinary communication between departments
- Develop interdisciplinary treatment concepts
These are in addition to a range of other diagnostic and/or therapeutic aspects that are difficult to predict in detail and cannot be adequately monitored with process indicators, and which therefore only become apparent during this comprehensive analysis of the overall process.
Who is responsible for implementing the selected measures?
The chief physician and the management board of the audited hospital are responsible for implementing the measures.
How is patient data protected?
Patients’ data protection rights are governed by the data protection laws of the respective federal state. It is the clinics’ responsibility to apply them correctly. Prior to each peer review, IQM obtains written confirmation from the clinic that the patient data to be used during the peer review has been correctly anonymised. In addition, each peer signs a confidentiality agreement for each peer review and is always bound by medical confidentiality.