Anonymous group peer review in surgery morbidity and mortality conference.
BACKGROUND
Surgical peer review might be characterized by assessment heterogeneity.


METHODS
We performed a prospective, anonymous, peer review of surgeon and system performance during a morbidity and mortality conference.


RESULTS
Twenty-two cases were reviewed by a mean of 48.9 respondents each, including attendings, fellows, and residents. A mean of 50% (standard deviation, 23%) of respondents identified some quality issue in each case, reflecting high heterogeneity. The mean percentage in identifying a system issue was 27%, and in identifying a physician issue was 37%. When identifying a physician issue, physician care was judged as appropriate by 72%, as controversial by 26%, or as inappropriate by 2%. Residents were more likely than attendings to identify system issues (odds ratio, 2.23) and physician issues (odds ratio, 3.58), but attendings were more likely to rate care controversial or inappropriate (odds ratio, 2.53).


CONCLUSIONS
Surgical peer reviews, even after group discussion, display substantial heterogeneity. Review methods should account for this heterogeneity.
Department of Surgery, School of Medicine, Washington University in St Louis and Barnes Jewish Hospital, Campus Box 8109, 660 South Euclid Ave., St. Louis, MO 63110-1093, USA.
Leila C
LC
Bender
Mary E
ME
Klingensmith
Bradley D
BD
Freeman
William C
WC
Chapman
William Claiborne
WC
Dunagan
Jonathan E
JE
Gottlieb
Bruce L
BL
Hall
D002983:Clinical Competence; D003226:Congresses as Topic; D013502:General Surgery; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D008923:Missouri; D009017:Morbidity; D009026:Mortality; D010380:Peer Review; D011446:Prospective Studies; D011785:Quality Assurance, Health Care