NNEPQIN CPRBNNEPQIN CPRBConfidential Peer Confidential Peer

Review BoardReview BoardA proposal for regional A proposal for regional

institutional institutional

review of care.review of care.

NNEPQIN Fall MeetingNNEPQIN Fall Meeting

November 14, 2009November 14, 2009

Jerome Schlachter, MDJerome Schlachter, MD

““Peer review is alive Peer review is alive only in rare pockets in only in rare pockets in

this country.”this country.”

--Richard Boothman, JD, Richard Boothman, JD, ACOG Today 2008ACOG Today 2008

AJOG, August AJOG, August 20082008

Improved outcomes, fewer cesarean deliveries, and reduced

litigation: results of a new paradigm in patient safety

Steven L. Clark, MD; Michael A. Belfort, MD, PhD; Spencer L. Byrum, LCDR (ret.) USCG;

Janet A. Meyers, RN; Jonathan B. Perlin, MD, PhD

Clark S, AJOG, Aug. 2008Clark S, AJOG, Aug. 2008

““Although some superb, effective local Although some superb, effective local peer review committees exist, those peer review committees exist, those seeking to establish such processes seeking to establish such processes face significant challenges, given face significant challenges, given current medical staff and hospital current medical staff and hospital board structures.”board structures.”

Clark S, AJOG, Aug. 2008Clark S, AJOG, Aug. 2008

““Effective peer review is essential to Effective peer review is essential to quality medical practice yet may be quality medical practice yet may be impossible to achieve at a local level impossible to achieve at a local level in some departments.”in some departments.”

HCA ProcessHCA Process

National committee supplements the National committee supplements the local committee.local committee.

Review committee composition: 14 Review committee composition: 14 OB, 3 Neo, 3 RN, including outside OB, 3 Neo, 3 RN, including outside experts.experts.

Cases of severe outcome: deaths, Cases of severe outcome: deaths, seizures, brachial plexus injury, seizures, brachial plexus injury, uterine rupture, ICH.uterine rupture, ICH.

Over 400 cases/yr., 97% consensus Over 400 cases/yr., 97% consensus reached.reached.

NNEPQIN CPRBNNEPQIN CPRB

ConfidentialConfidential

Peer Peer

Review Review

BoardBoard

NNEPQIN CPRBNNEPQIN CPRB

Part of a comprehensive, region-Part of a comprehensive, region-wide, patient safety agenda.wide, patient safety agenda.

Available for institutions that want Available for institutions that want to supplement their internal to supplement their internal perinatal quality assurance program perinatal quality assurance program with a regional case review process. with a regional case review process.

A single case or a series of cases A single case or a series of cases may be appropriate. may be appropriate.

NNEPQIN CPRBNNEPQIN CPRB

Mission:Mission:

To provide an in-depth, multidisciplinary To provide an in-depth, multidisciplinary analysis of unanticipated perinatal analysis of unanticipated perinatal outcomes in the region.outcomes in the region.

To support learning from systems To support learning from systems failures. failures.

To improve assessment for, anticipation To improve assessment for, anticipation of and prevention of adverse perinatal of and prevention of adverse perinatal events. events.

NNEPQIN CPRBNNEPQIN CPRBStructureStructure

PersonnelPersonnel Physician chair rotatesPhysician chair rotates Nurse review coordinator (DHMC)Nurse review coordinator (DHMC) 1 MD, 1 RN from each institution1 MD, 1 RN from each institution Additional specialty representationAdditional specialty representation

Members must attend at least one Members must attend at least one meeting/yr.meeting/yr.

No attendance = no case review.No attendance = no case review.

NNEPQIN CPRBNNEPQIN CPRBStructureStructure

Two meetings held per year.Two meetings held per year. Hospitals, patients or providers Hospitals, patients or providers

initiate review.initiate review. Hospitals collect and submit Hospitals collect and submit

information.information. Chair assigns cases for presentation.Chair assigns cases for presentation. Cost: $50 per case.Cost: $50 per case.

NNEPQIN CPRBNNEPQIN CPRBProcessProcess

Hospitals may submit all or selected cases.Hospitals may submit all or selected cases. Examples:Examples:

5’ Apgar <= 3 or intrapartum IUFD5’ Apgar <= 3 or intrapartum IUFD Maternal death or unanticipated ICU Maternal death or unanticipated ICU

admissionadmission Term non-anomalous NICU admission/transferTerm non-anomalous NICU admission/transfer Umbilical blood gas < 7.0 or base excess > 12Umbilical blood gas < 7.0 or base excess > 12 Return to OR after prior operative procedure Return to OR after prior operative procedure

in ORin OR Requirement for Massive Transfusion: 6 more Requirement for Massive Transfusion: 6 more

units of blood productunits of blood product

NNEPQIN CPRBNNEPQIN CPRBProcessProcess

Requested records are blinded by the Requested records are blinded by the HospitalHospital Last 2 hours of the fetal heart rate tracingLast 2 hours of the fetal heart rate tracing Admitting H&P and all provider progress notesAdmitting H&P and all provider progress notes Labor flow sheets and other flow sheets as Labor flow sheets and other flow sheets as

appropriateappropriate Laboratory dataLaboratory data Nursing progress notesNursing progress notes Delivery note and discharge summaryDelivery note and discharge summary Newborn birth summary, discharge summary and Newborn birth summary, discharge summary and

progress notes as appropriateprogress notes as appropriate Relevant care guidelines and policiesRelevant care guidelines and policies

NNEPQIN CPRBNNEPQIN CPRBProcessProcess

Blinded confidential case Blinded confidential case presentation and review.presentation and review.

Consensus decision of board.Consensus decision of board. Report forwarded to hospital Q/A Report forwarded to hospital Q/A

committee and the NNEPQIN PSO.committee and the NNEPQIN PSO. Hospital records destroyed.Hospital records destroyed.