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Peer Review in Endocrinology

Peer Review in Endocrinology. John S. Bevan Peer Review Coordinator Society for Endocrinology. Definition (Van Weedt, 2000). Formalized event – explicit pre-determined procedures & questionnaires – standards for reports Information derived from documentation, observation and verbal

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Peer Review in Endocrinology

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  1. Peer Review in Endocrinology John S. Bevan Peer Review Coordinator Society for Endocrinology

  2. Definition (Van Weedt, 2000) • Formalized event – explicit pre-determined procedures & questionnaires – standards for reports • Information derived from documentation, observation and verbal • Standards of good quality and best practice to be used where available • Scope – clinical care process and its organisational aspects

  3. Experience of other specialities • Thoracic medicine • Renal medicine • Cardiology

  4. British Thoracic Society Aims • To increase clinical effectiveness & improve patient care • To benefit reviewed unit • To benefit reviewers Ethos • Voluntary, supportive & non-confrontational • But also tough and thorough Richard Page & Brian Harrison. Journal RCP (London), 1995, 29: 319-24

  5. Endocrinology Peer Review • John Wass initiative.... • Setting appropriate Standards for Clinical Endocrinology • British Thoracic Society • Clinical Standards Board for Scotland • Clinical Committee consultation on draft • Ten standards agreed • First pilot visits

  6. Ten Standards: Clinical Endocrine Care • Initial referral & assessment • Patient focus • Communication • Endocrine function testing • Interface with biochemistry • Endocrine imaging • Interface with endocrine pathology • Links with other specialities • High-cost endocrine therapies • Endocrine audit & databases

  7. Endocrine Standards – example

  8. Assessing the Standards

  9. Endocrine Standards - example

  10. Supporting documents http://www.endocrinology.org/about/projects/peerreview.html

  11. Planning a Peer Review Visit • Centre selection • Basic model (TH-DGH) • Tailored model • Reviewer recruitment • Setting the timelines

  12. Planning a Peer Review Visit • Centre selection • Basic model (TH-DGH) • Tailored model • Reviewer recruitment • Setting the timelines

  13. Timelines 2-day Peer Review Visit Final reports & feedback questionnaires Initial planning: places, people & dates Visit timetables Draft reports checked SAQ-out SAQ-back Draft reports -16 -8 -4 -2 0 +4 +6 +8 weeks

  14. Pre-visit Questionnaire Section 12: LOCAL PERCEPTIONS FOR CHANGE What are the changes most wanted by the endocrine unit? How would they like the endocrine unit to be developed? Does this relate to any of the local NHS priorities for change? • General information about region • Outpatient & inpatient workloads • Staffing levels • Facilities for endocrinology • Support services: admin, lab, imaging • Speciality links • Audit and research

  15. What happens during a PRV? • Pre-visit preparation is vital • Visits to people, places and events • Recording – using the report form • Preliminary feedback • Decisions on report writing & deadlines

  16. During a visit there’s a lot to fit in!

  17. What does the Final Report look like?

  18. What happens to the Final Report?

  19. PR – extracting the digit!

  20. Who’s been visited? • Sheffield-Chesterfield • Oxford-Reading • Hull-York • Glasgow THs • Manchester-Pennine • Stoke-Shrewsbury • Nottingham-Derby • Bristol-Taunton • Cambridge-Ipswich • 20 hospitals providing • endocrine services • 14 teaching hospitals • 6 district general hospitals

  21. Who’s done the work? • James Ahlquist • Steve Atkin * • John Bevan # • John Connell * • Julian Davis * • Mohgah Elsheikh * • Nick Finer # • Stephen Gallacher * • Ashley Grossman • Colin Johnston • Tara Kearney * • Bill Kelly • John Miell • John Newell-Price * • John Wass * * Volunteered after PRV to their centre # Undertook 2 or more PRVs

  22. So, has it been worth all the effort?

  23. How was it for the reviewed centres? (20-item questionnaire – sent 2 months after visit – 65% RR)

  24. Reviewed consultants said... • ‘I believe the PRV was very important – our MD and CEO used the report to lobby PCTs whenever they had a chance’ (DGH) • ‘It got us all thinking about what we do’ (TH) • ‘Excellent report captured all the current issues within our department & the city as a whole’ (TH) • ‘Many thanks to the reviewers for their supportive attitude and for stimulating discussion’ (TH) • ‘We often feel a bit isolated....so it was reassuring to learn we’re actually doing quite well!’ (DGH)

  25. How was it for the reviewers? (17-item questionnaire – sent 2 months after visit – 61% RR)

  26. Reviewers said... • ‘I found it very valuable & it led to more reflection about our own unit’ (TH) • ‘Thanks for allowing me to be a Reviewer – I found it to be an absolutely invaluable & incredibly useful experience’ (DGH) • ‘Excellent development – I benefited from a peer review visit and was happy to reciprocate for the Society’ (TH) • ‘A beneficial, albeit exhausting, exercise for me!’ (TH) • ‘Gave me some good ideas for updating my own protocols and PILs!’ (TH)

  27. Reviewers ‘pick up’ good ideas!

  28. How well did the endocrine centres do?‘Essential’ standards (n=30) Percent 84% 82% DGHs Teaching hospitals

  29. How well did the endocrine centres do?‘Desirable’ standards (n=18) Percent 55% 45% Teaching hospitals DGHs

  30. How well did the endocrine centres do?‘Desirable’ standards (n=18) Percent 25% 32% Teaching hospitals DGHs

  31. Types of Recommendation Total = 128 (71 ‘major’ & 57 ‘minor’) Number

  32. Progress on 128 PRV Recommendations... after a mean interval of 3.4 years (range 1-7) ...100% update! 9 Consultants 5.5 Nurses 2 Secretaries Only 4% Funding constraints on 9 staffing posts & 6 facility improvements Number

  33. Other benefits of peer review How does my centre compare to others in the UK? Workload Waiting times Administration Imaging access

  34. Activity comparisons between hospitals“Out-patients seen per Consultant DPA” C C C N C C Teaching hospitals DGHs

  35. Some quality indicatorsStandard 1: Initial referral & assessment

  36. Some quality indicatorsStandard 3: Communication

  37. Some quality indicatorsStandard 6: Endocrine imaging

  38. What are the problems? • Agreeing the dates • Understanding the objectives • Selecting the centres (especially DGH) • Recording the data • Time • Finance

  39. Where now…..in the decade of Revalidation? • Encourage wider UK roll-out • Still voluntary • Who else can review our specialist activities and team-working? • New PRV Coordinator, 2010 • Dr Petros Perros, Newcastle • Endocrine nurse involvement? • Workload comparisons? • Quality indicators? • Bench-marking?

  40. Next round of visits... • Sheffield-Chesterfield • Oxford-Reading • Hull-York • Glasgow • Manchester-Pennine • Stoke-Shrewsbury • Nottingham-Derby • Bristol-Taunton • Cambridge-Ipswich • Aberdeen-Inverness • London-K/G/T • London-H/CC • Plymouth-Exeter • Belfast- • Cardiff- • Leeds-

  41. Grateful thanks to ... • Volunteers: Centres and Reviewers • Society for Endocrinology supporters • Clinical Endocrinology Trust

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