Peer Review and Quality Assurance in Plastic Surgery

Objective:  Physician peer review poses unique challenges in academic Plastic Surgery, especially when the faculty members have diverse interests and minimal overlap in practice patterns.  Reluctance to participate in such programs may also be observed, due to perceived lack of benefit for patients and/or unwanted scrutiny of individual complication rates and practices.  Nonetheless, peer review is an important component of improving patient safety, and some form of peer review/quality assurance is required for hospital accreditation.¹

Methods:  At the University of Michigan, we have implemented a comprehensive peer review program based not only on self-reporting of adverse occurrences, but also on rate indicator data obtained from Clinical Information & Decision Support Services (CIDSS).  This central data-gathering group is able to compile provider-specific data on quality-related rate indicators of interest to Plastic Surgeons, namely:

• Rate of unplanned readmissions within 30 days of discharge
• Rate of unplanned returns to the operating room within 30 days of surgery
• Rate of improper antibiotic selection, timing, and/or dosing before surgery
• Rate of postoperative surgical site infections
• Rate of improper selection of appropriate prophylaxis for venous thromboembolism (VTE)
• Rate of unwarranted antibiotic usage for short, clean procedures

Results:  Incorporation of this data into a quarterly physician dashboard, comparing each faculty member to their peers, was instituted in 2008.  By implementing this feedback loop, as well as other systems-based interventions, we have been able to track the quality of our “product” over time, and observe responses to interventions in a timely fashion.  For example, after intervening with a “hard stop” order entry query about VTE prophylaxis, compliance with this patient safety metric improved from 35% to 100%. 

Conclusion:  In summary, our novel peer review process has led to definite improvements in patient safety at the University of Michigan Plastic Surgery Section.  Despite initial concerns, faculty acceptance of the program has been broadly optimistic, once the obvious benefits to patient care became apparent.