An Opportunity for YPS Members to Re-Think the Peer Review Process

 

PeerLearning 

Many radiology practices are not routinely meeting the goals of providing timely feedback to radiologists in a way that meets the needs of their stakeholders. The peer review process for radiologists is imperative to success building for those we routinely take care of.

In fact, the 2015 Institute of Medicine report on Improving Diagnosis in Health Care highlighted the urgent need for comprehensive, non-punitive review of diagnostic errors to facilitate learning and process improvement. Simply reviewing past cases have traditionally been done as a part of the peer review process and accreditation- mandated. Focused/ongoing professional practice evaluation has not adequately met this challenge.

Several sites have now added and implemented versions of “peer learning.” The process seeks to separate the monitoring or performance, including identifying opportunities for learning and improvement. While the process may initially seem similar to peer review, there are several important differences. They include: PeerLearning2

  1. Case selection to focus on randomly assigning a representative a sample of recently performed cases tailored to the individual practice and expertise of each radiologist. Such cases have the greatest opportunity to offer a timely impact on patient care while providing the greatest possible benefit to learning among radiologists.
  2. Numerical scores or grades should be replaced with qualitative descriptors regarding agreement as well as any opportunities for learning or improvement. These can include classifying disagreement on the type of error (e.g. perceptual versus cognitive) or methods to improve reporting and communication.
  3. Peer learning conferences can be established to facilitate group learning, support open discussion, and create a non-punitive environment within the department.

Peer learning conferences can take many forms, including review of individual reports for consensus or as a case conference discussing opportunities for learning as well as “great calls” made. Such conferences should anonymize all patient and interpreting radiologist information and require a dedicated conference leader or team to ensure success. When performed in addition to the peer learning process, the conferences provide another opportunity for timely review of recent cases and can facilitate improvements in overall patient care.

In 2018, more groups will embark on the peer learning process. We hope members of the YPS will help champion these activities.

Please see the references below to further learn about the process. Individuals who are interested in this topic should also consider attending the 2018 ACR Annual Conference on Quality and Safety in Boston, Mass.


 

MoriarityHeashot

Andy Moriarity, MD, is a radiologist in Grand Rapids, Mich.

ENDNOTES

Alkasab, TK, Harvey, HB, Gowda, V, Thrall, JH, Rosenthal, DI, Gazelle, GS. Consensus-oriented group peer review: a new process to review radiologist work output. J Am Coll Radiol. 2014;11:131–138. http://dx.doi.org/10.1016/j.jacr.2013.04.013

Donnelly LF, Dorfman SR, Jones J, Bisset GS III.  Transition from Peer Review to Peer Learning – Experience in a Radiology Department.  J Am Coll Radiol – 2017 in press. http://dx.doi.org/10.1016/j.jacr.2017.08.023

Larson DB, Donnelly LF, Podberesky DJ, Merrow AC, Sharpe RE, Kruskal JB.  Peer Feedback, Learning, and Improvement: Changing Radiology Peer Review to Meet the Charge of the Institute of Medicine’s 2015 Report on Diagnostic Error. Radiology 2017;283:231-241. http://doi.org/10.1148/radiol.2016161254 /dcs

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