Characteristics of the Quality Improvement Content of Cardiac Catheterization Peer Reviews in the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Abstract

Key Points Question Do peer reviews of cardiac catheterization laboratory complications provide useful content for quality improvement? Findings In this quality improvement study, 152 cardiac catheterization cases selected for peer review because of the occurrence of a major adverse event were analyzed, and only 16.4% of cases were adjudicated as not meeting the standard of care. Concerns about operator performance and judgment were more common, and reviewers recommended improvements in operator performance and care processes in 41.4% and 38.2% of cases, respectively. Meaning Peer review programs should focus on maximizing quality improvement opportunities even when the standard of care is met.

SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup

“…10,11 In the Veterans Administration (VA) Healthcare System, complications continue to decline and remain below 1%. 7 Development of multidisciplinary conferences 12 and national peer review systems 13 may also serve to ensure better case selection and management of complications. Increased use of radial access, 7,11 changes in procedural methods, and improvements in PCI equipment including physiological assessment and intravascular imaging may all be associated with this reduction in periprocedural complications.…”

Peer evaluation and feedback for invasive medical procedures: a systematic review

“…After review of references of these articles, we included an additional 9 studies. The final sample of 32 studies included 21 from the subspecialty of gastroenterology , 5 from cardiology [42][43][44][45][46], 3 from pulmonology [47-49], and 3 from IR [50-52] (Table 1).…”

“…Feedback to clinicians was described in 10 studies [22,23,28,32,[42][43][44][50][51][52]. Feedback methods included personalized score cards, letters from review committees, and group discussion during case conferences.…”

“…Common elements included pre-specified criteria for case selection, a protected and non-punitive environment, and a focus on education and quality improvement. Doll et al described a national peer review committee for PCI complications that provided operators with an overall rating and recommendations for improvement [43]. Luo et al proposed that peer review in a group setting allows the operator an opportunity to provide context and rationale for clinical management [52].…”