Individual case review is an important mechanism for peer assessment and quality improvement. Today, most case reviews of hospitalized patients are performed in an unstructured manner outside the context of a broader quality improvement framework. Aside from resource‐intensive root cause analyses, hospitals lack simple, systematic case review tools. Given trends in performance measurement, there is a growing imperative for hospitalist groups to develop robust case review methods to proactively identify quality and safety issues in an efficient and effective manner.
We report the development and implementation of a structured individual case review tool to aid quality analysis in an academic hospitalist group.
The case review tool (CRT) was developed in phases. We collected case review tools both from committees in our medical center and from peer hospital medicine groups and conducted a literature search for nationally published tools. We formulated a draft of our tool based on the London protocol and other relevant tools identified through our search. Our division's quality and safety committee piloted the CRT over 3 months, soliciting feedback from each reviewer. The final version of the CRT gathers basic demographic details, including case source, patient diagnoses, inpatient location, staff members involved, and materials reviewed. It then prompts the reviewer to focus on several key facets of quality: specific care delivery problems; preventable outcomes, concerns about the performance of the team or individual physicians, aspects that point to systems‐related issues, aspects that are commendable or potential best practices, and an overall case rating ranging from no identified issues to major quality issues. Reviewed cases are presented at a confidential monthly quality meeting, where items for further inquiry or quality improvement are initiated and tracked.
The CRT provides a facile, standardized approach to case review. It trains the reviewer to think stepwise through quality issues that might otherwise be overlooked, increasing face validity and reliability across reviewers. It creates searchable fields (nursing unit, type of care delivery problem, etc.), allowing trend identification. In our division, the CRT has facilitated an efficient, systems‐oriented quality infrastructure. The CRT is neither disease‐ nor process specific and thus is broadly adaptable for review of different patient case types that arise within hospitalist groups.
J. Lee, none.
To cite this abstract:Lee J, Vidyarthi A. A Case Review Tool for Quality Analysis. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 111. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/a-case-review-tool-for-quality-analysis/. Accessed November 13, 2019.