A collegial, collaborative peer review process is an important piece of the quality program in any hospital or healthcare system. In our work with emergency physicians and hospitalists, we understand that patient outcomes for those admitted through the emergency department are deeply affected by both specialties. We must develop multi-disciplinary peer review committees with representation from both practices, as well as from nursing and administration.
This committee should meet monthly (unless there is an urgent need for case review) and will evaluate individual cases as well as departmental quality indicators.
Individual cases typically are generated from one of the following:
- Non-scheduled return to the ED within 72 hours
- Patient complaint
- Complaint from nursing or medical staff
- Core Measure fall-out
In addition, the team will look at overall quality measures such as:
- Sepsis bundle compliance and mortality
- Opioid prescribing
- Stroke care
- Patient Experience scores
- ED flow metrics and hospital length of stay
- 30-day readmissions
- Appropriate utilization of ICUs and Observation Units
This committee is developed with assistance from the leadership team and will create a collegial, educational experience for all committee members and will serve to provide continuous education for our physicians and APPs with the result being a safer patient experience. Regardless of the opinions of the committee, all provider-related patient complaints are tracked by our practice coordinators and all patients are called by the Medical Director to better understand the issue and to provide service recovery. A follow up letter is also mailed to the patient to ensure closure of the situation.
When looking for ways to increase teamwork and accountability between emergency physicians and hospitalists, combining both services under a single provider group can be beneficial. However, even if they are not part of the same physician group, shared goals and a shared peer review are meaningful next steps to driving culture change and quality improvement at your organization.