(Peer) Evaluations in PP

[Colba55o]

Question for those in private practice (not academics with residents): How do you conduct evaluations of your partners/coworkers? Are there written questionnaires sent out to just other anesthesiologists that are collected by the chief? Do evals go out to surgeons, nurses, other staff? Are the evals anonymous?
It seems difficult to truly have peer evaluations in our field since we often work by ourselves and arent usually in a position to evaluate each other.

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[IlDestriero]

We have done chart reviews in all of the places that I have worked, including mandatory reporting of a list of specific events. Our current system can electronically tag a case for CQI review. You hit a button and the CQI team takes it from there.

 

[Noyac]

We don't have a formal process. We have discussed the process and how to implement one but I find it difficult. I can do chart reviews, talk with surgeons, we have QCI triggers but none of these are ideal. Personally, I walk into a new members OR and just talk to them, give breaks read their chart, etc. I have a few partners I trust and we will discuss any issues. This is the best I have come up with. It's not ideal.

 

[IlDestriero]

Random chart review is a lot more useful with electronic charting. We also have built in auto recording of abx administration compliance, signatures, sign outs, post op pain scores on arrival, hypothermia, etc.
We have talked about doing 360° evals for years, but it is a big job.
When there are concerns about an attending it triggers more reviews and some discrete inquiries about their performance.
Anyone can anonymously, or not, report a safety event electronically at any time. They are all evaluated through risk management and the appropriate departments. They can be systems, equipment, patient or staff issues, near misses, etc. Getting people to fill them out is another problem, though it only takes less than 5 min. I've been guilty of not filling them out myself when I should have.
We have one faculty member that should probably be asked to find a new job, it is just a matter of time...

 

[aneftp]

PP places not run by AMCs need to heed warning. It's things like this that AMCs can present as "quality control measures" to hospital administration.

If you are in PP and don't have "peer review" or other performance measures that some what shows some unbiased attempt, than you need to have one in place.

Anything is better than nothing in this era of anesthesia.

 

[BuzzPhreed]

If you are in PP and don't have "peer review" or other performance measures that some what shows some unbiased attempt, than you need to have one in place.

It is required by the ACA now. It rolled out a couple of years ago. While mostly centered on fraudulently billing, it implicitly includes such things as training and education. It also discusses "harmonizing" peer review with current broadly accepted standards of care (i.e. need to align best practices with national standards, and report those doctors who practice outside those standards). At our hospital, all new hires (staff) are required to be reviewed and an evaluation submitted. We also amended our staff bylaws to make mandatory a one-year "probationary" period before you can be a fully-admitted member of the medical staff (used to be 3 months). I had to do this on a guy we hired despite the fact that he's been practicing without issues since the late 1990s.

http://healthaffairs.org/blog/2012/...d-licensure-systems-and-hospital-peer-review/

http://www.medpagetoday.com/PracticeManagement/PracticeManagement/39487

This is a double-edged sword. You're sticking your neck out (positive or negative) for someone you don't really know. People can fly under the radar in various ways and for a long time before real performance issues surface. And putting your name on a peer evaluation may have significant ramifications for yourself. Caveat emptor.

 

[Ignatius J]

It is required by the ACA now. It rolled out a couple of years ago. While mostly centered on fraudulently billing, it implicitly includes such things as training and education. It also discusses "harmonizing" peer review with current broadly accepted standards of care (i.e. need to align best practices with national standards, and report those doctors who practice outside those standards). At our hospital, all new hires (staff) are required to be reviewed and an evaluation submitted. We also amended our staff bylaws to make mandatory a one-year "probationary" period before you can be a fully-admitted member of the medical staff (used to be 3 months). I had to do this on a guy we hired despite the fact that he's been practicing without issues since the late 1990s.

http://healthaffairs.org/blog/2012/...d-licensure-systems-and-hospital-peer-review/

http://www.medpagetoday.com/PracticeManagement/PracticeManagement/39487

This is a double-edged sword. You're sticking your neck out (positive or negative) for someone you don't really know. People can fly under the radar in various ways and for a long time before real performance issues surface. And putting your name on a peer evaluation may have significant ramifications for yourself. Caveat emptor.

Unless there are some very good controls, having surgeons involved in peer evals seems like a very bad idea. Some may pretend they know, but I would not entrust them to in part decide whether my colleagues are delivering safe anesthesia care.

 

[Numbex]

Unless there are some very good controls, having surgeons involved in peer evals seems like a very bad idea. Some may pretend they know, but I would not entrust them to in part decide whether my colleagues are delivering safe anesthesia care.

Hear, hear. Surgeons aren't any more qualified to peer-review us than we are to peer-review them.