title: Voluntary peer review as innovative tool for quality improvement in the intensive care unit--a retrospective descriptive cohort study in German intensive care units.
abstract: BACKGROUND
  Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports.
  
  
  METHODS
  Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs - representing over 300 patient beds - had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented.
  
  
  RESULTS
  External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kumpf
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Bloos
authors.affiliation: Quality Committee of the State Chamber of Physicians, Hamburg, Germany.
authors.forename: Hanswerner
authors.initials: H
authors.lastname: Bause
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Klinikum Heidenheim, Heidenheim, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Brinkmann
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Deja
authors.affiliation: Department of Intensive Care Medicine, Universitätsklinikum RWTH Aachen, Aachen, Germany.
authors.forename: Gernot
authors.initials: G
authors.lastname: Marx
authors.affiliation: Kreiskliniken Reutlingen GmbH, Reutlingen, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Kaltwasser
authors.affiliation: Kreiskliniken Reutlingen GmbH, Reutlingen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Dubb
authors.affiliation: Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Muhl
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Klinikum Fulda, Fulda, Germany.
authors.forename: Clemens-A
authors.initials: CA
authors.lastname: Greim
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiler
authors.affiliation: German Medical Association, Berlin, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Chop
authors.affiliation: German Medical Association, Berlin, Germany ; State Chamber of Physicians Berlin, Berlin, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Jonitz
authors.affiliation: State Chamber of Physicians Berlin, Berlin, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Schaefer
authors.affiliation: State Chamber of Physicians Baden-Württemberg, Stuttgart, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Felsenstein
authors.affiliation: State Chamber of Physicians Thüringen, Jena, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Liebeskind
authors.affiliation: State Chamber of Physicians Schleswig-Holstein, Bad Segeberg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Leffmann
authors.affiliation: State Chamber of Physicians Hamburg, Hamburg, Germany.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Jungbluth
authors.affiliation: Trauma Surgery Department, University Hospital Essen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Waydhas
authors.affiliation: The Johns Hopkins University School of Medicine, Departments of Anesthesiology/Critical Care Medicine and Surgery, Baltimore, Maryland, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Pronovost
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helios Klinikum Hildesheim, Hildesheim, Germany.
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Braun
mesh_terms: D005858:Germany; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards*; D010380:Peer Review / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D035141:Voluntary Programs
keywords: critical care; patient safety; peer review; quality improvement; quality management