Andrew J Hale1, Ryan W Nall, Kenneth J Mukamal, Howard Libman, C Christopher Smith, Scot B Sternberg, Hans S Kim, Gila Kriegel. 1. A.J. Hale is clinical fellow, Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. R.W. Nall is assistant professor, Department of Medicine, Division of General Internal Medicine, University of Florida, Gainesville, Florida. K.J. Mukamal is associate professor of medicine, Harvard Medical School and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. H. Libman is director of ambulatory residency training, Department of Medicine, Beth Israel Deaconess Medical Center, and professor of medicine, Harvard Medical School, Boston, Massachusetts. C.C. Smith is associate professor of medicine, Harvard Medical School, and director, Internal Medicine Residency Training Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts. S.B. Sternberg is administrative director of quality improvement, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. H.S. Kim is assistant professor of medicine, Harvard Medical School, and faculty physician, Healthcare Associates, Beth Israel Deaconess Medical Center, Boston, Massachusetts. G. Kriegel is assistant professor of medicine, Harvard Medical School, and director of quality improvement, Healthcare Associates, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abstract
PURPOSE: Performing and teaching appropriate follow-up of outpatient laboratory results (LRs) is a challenge. The authors tested peer-review among residents as a potentially valuable intervention. METHOD: Investigators assigned residents to perform self-review (n = 27), peer-review (n = 21), or self- + peer-review (n = 30) of outpatient charts. They also compared residence performance with that of historical controls (n = 20). In September 2012, residents examined 10 LRs from April 2012 onward. A second review in November 2012 ascertained whether performing chart review improved residents' practice behaviors. RESULTS: Initially, the least-square (LS) mean number of LRs without documentation of follow-up per resident in the self-, peer-, and self- + peer-review group was, respectively, 0.5 (SD 1.0), 1.0 (SD 1.7), and 0.9 (SD 1.3), and post intervention, this was 1.0 (SD 0.2), 0.3 (SD 0.2), and 0.6 (SD 0.2) (self- versus peer-review P = .03). Initially the LS mean follow-up time per resident in the self-, peer-, and self- + peer-review group was, respectively, 4.2 (SD 1.2), 6.9 (SD 1.4), and 5.9 (SD 1.2) days, and after the intervention, LS mean time was 5.0 (SD 0.5), 2.5 (SD 0.6), and 3.9 (SD 0.5) days (self- versus peer-review P < .01). Self-review was not associated with significant improvements in practice. CONCLUSIONS: In this comparison of self- and peer-review, only residents who performed peer-review demonstrated significant improvements in their documentation practices. These findings support the use of resident peer-review in improving LR follow-up, and potentially, in other, broader resident quality improvement initiatives.
PURPOSE: Performing and teaching appropriate follow-up of outpatient laboratory results (LRs) is a challenge. The authors tested peer-review among residents as a potentially valuable intervention. METHOD: Investigators assigned residents to perform self-review (n = 27), peer-review (n = 21), or self- + peer-review (n = 30) of outpatient charts. They also compared residence performance with that of historical controls (n = 20). In September 2012, residents examined 10 LRs from April 2012 onward. A second review in November 2012 ascertained whether performing chart review improved residents' practice behaviors. RESULTS: Initially, the least-square (LS) mean number of LRs without documentation of follow-up per resident in the self-, peer-, and self- + peer-review group was, respectively, 0.5 (SD 1.0), 1.0 (SD 1.7), and 0.9 (SD 1.3), and post intervention, this was 1.0 (SD 0.2), 0.3 (SD 0.2), and 0.6 (SD 0.2) (self- versus peer-review P = .03). Initially the LS mean follow-up time per resident in the self-, peer-, and self- + peer-review group was, respectively, 4.2 (SD 1.2), 6.9 (SD 1.4), and 5.9 (SD 1.2) days, and after the intervention, LS mean time was 5.0 (SD 0.5), 2.5 (SD 0.6), and 3.9 (SD 0.5) days (self- versus peer-review P < .01). Self-review was not associated with significant improvements in practice. CONCLUSIONS: In this comparison of self- and peer-review, only residents who performed peer-review demonstrated significant improvements in their documentation practices. These findings support the use of resident peer-review in improving LR follow-up, and potentially, in other, broader resident quality improvement initiatives.
Authors: Jason Hom; Ilana Richman; Jonathan H Chen; Baldeep Singh; Casey Crump; Jeffrey Chi Journal: BMC Med Educ Date: 2016-05-10 Impact factor: 2.463