Peer Review and Case Finding

QualityCRN1 · Sep 25, 2013

Also, how do databases play a part in quality?? I understand hospitals subscribe and initiate databases but what is the benefit?

Caribbean_cruzin · Oct 24, 2013

I currently work in Quality Management. I do the abstraction for Core Measures and have done some peer review. I would agree it can be a bit difficult to figure out how to match the case with the indicators initially. Our peer review process is specific to physicians. We have reports that are related to some of our indicators. We run monthly reports that encompass readmits within 7 days (an indicator), complications (related to numerous indicators), returns to the OR, OB complications, mortality review to name a few. We also get our cases by way of an event reporting system. This system is used to anonymously allow nurses, physicians, pretty much anyone employed by the hospital to report concerns related to care or behavior, major events, code blue calls, RRT calls, etc.

The nurse reviewer screens those reports and determines whether or not it is in need of further review by a physician who is on our peer review committee, a multidisciplinary committee. If not, it is screened and closed by the RN who then databases the case in the system we use which is MIDAS +. If there is need for further review it is written up in detail for a physician to review then brought to the committee for determination.

You asked what benefit it is to subscribe to and participate in a "database". First, it is used to report the required core measures to CMS. The vendor, in our case MIDAS+, submits on our behalf. Databasing helps with areas of improvement, it is also a way to keep track of the physicians reappointments and how they have performed on the core measures, how many times they were suspended, and other things.

I hope this helps! I would be happy to give you more information if you need it.