Kerri Clark, MSN, CPNP-AC, CCRN
Pediatric Critical Care Nurse Practitioner
Akron Childrens Hospital
Akron, Ohio
Disclosure information not submitted.
Amy McHenry, DNP, CPNP-AC
Co-Lead APP
Akron Childrens Hospital, United States
Disclosure information not submitted.
Kevin Baker, MSN, BSN, RN
Manager, Provider Peer Review
Akron Children's Hospital, United States
Disclosure information not submitted.
Christopher Page-Goertz, MD
Assistant Professor
Akron Childrens Hospital, United States
Disclosure information not submitted.
.jpg "James Besunder, DO, FCCM photo")
James Besunder, DO, FCCM
Director, Division of Pediatric Critical Care and Medical Director, PICU
Akron Childrens Hospital
Akron, Ohio
Disclosure information not submitted.
Michael Bigham, MD, FAAP,FCCM
Chief Quality Officer
Akron Childrens Hospital
Akron, Ohio
Disclosure information not submitted.
Title: PICU Peer Review: Achieving an Integrated Physician/Advanced Practice Provider Model
Introduction: Peer review (PR) is used to evaluate colleague’s performance and identify areas of individual provider improvement. Though advanced practice providers (APPs) are employed in healthcare systems and integrated into medical staffs, APPs involvement in the PR processes is inconsistent. We describe the successful integration of the PICU APPs into the provider PR process.
Methods: The study describes the assimilation of APPs in the provider PR system at a free-standing children’s hospital PICU. A case review process began in 2001 and was modified into provider PR in 2015. Provider PR exclusively relied on physician review even for APP cases, lacking APP input and presence on the PR committee. Since December 2019, the PR process fully integrated APPs. Monthly PR meetings consist of 5-7 PICU physicians, 3-5 APPs, and a PR specialist facilitating the reviews. The indicators that trigger PR are similar for physicians and APPs, and self-referral of cases is encouraged beyond triggers. Triggers, trends, and provider practice patterns are tracked and reported in ongoing professional practice evaluations and at recredentialing. Cases with improvement opportunities identified result in direct feedback from the division director or lead APP to the provider, provider-specific focused provider professional practice improvement plan, or system-level improvements with cause analysis.
Results: During the study period of Oct 2015-Apr 2021, there were 9,659 PICU admissions and 526 cases were reviewed (5.4%): 512 for triggers and 14 self-referrals. Of the 526 cases, opportunities were identified in 109 cases (20.1%): 91 clinical, 17 documentation, 1 care deviation. 417(79.3%) had no opportunities identified. APP-attributed cases accounted for 35 (6.7%) reviews. The most common indicators for APP attribution were unplanned return to the PICU after transfer (< 24h) and delay in treatment. Less common triggers included medication errors, code blue events, and central line placement complication. Of the 35 APP cases, there were 14 opportunities (40%): 12 clinical, 2 documentation, and 0 care deviations.
Conclusion: PR is an important to ensure that high quality patient care standards are met. The modern PICU has integrated APP staff within the care team and we present a contemporary PR model that achieves similar integration.