Ultimately, it is not just the patient, but also the hospital that benefits from this.
Professor Elke Muhl is the spokesperson for the National Governance Working Group for this process. At MEDICA.de, the DIVI President explains the execution and objectives of these peer reviews.
Professor Muhl, peer reviews have prevented several accidents caused by reactor trips at nuclear power plants over the past few decades and serve as a model. Why does this process also make sense in intensive care units?
Elke Muhl: Approximately 2.1 million patients per year are treated at intensive care units in Germany – suffering from acute life-threatening diseases and a significant percentage of organ failure. It is vital for these patients to receive the best possible treatment in these facilities. If that is not the case, there are consequences affecting subsequent conditions and secondary complications and perhaps even mortality rates. In this respect, you can definitely compare the risk situation in an intensive care unit to a nuclear power plant. This is why it is so important for us to emphasize quality in this instance.
How does a peer review work and who is in the review team?
Muhl: The ward that would like to conduct this type of process first indicates this to its respective medical association, which in turn organizes a peer review team. The team consists of a critical care nurse, a critical care physician and usually a representative of the medical association. The peers undergo training beforehand where they learn what and how they need to inquire and audit for a review.
The ward receives a questionnaire with 52 questions about structure, process and outcome quality and a questionnaire with ten quality indicators. The team at the ward looks at the quality it provides, which is something that is only rarely done in everyday life. The peer review team receives the filled out questionnaires, so it is able to obtain some pre-information. It then visits and surveys the ward on one day. The peers ask questions about the questionnaires, talk to the employees and look at operational procedures and documentation. They check whether staff is really informed about certain proceedings and was not just claiming this in the questionnaire. There is a final review with nurse management at the end of the day. As a follow-up, the peer review group conducts an on-site analysis in which the ward’s strengths, opportunities, weaknesses and risks are being rated and the percentage of quality indicators implemented at the ward assessed. One important thing to note here is that wards never receive 100 percent! Otherwise, we would not have a need for improvement.