title: The Effects of Resident Peer- and Self-Chart Review on Outpatient Laboratory Result Follow-up.
abstract: Performing and teaching appropriate follow-up of outpatient laboratory results (LRs) is a challenge. The authors tested peer-review among residents as a potentially valuable intervention.
  
  
  
  Investigators assigned residents to perform self-review (n = 27), peer-review (n = 21), or self- + peer-review (n = 30) of outpatient charts. They also compared residence performance with that of historical controls (n = 20). In September 2012, residents examined 10 LRs from April 2012 onward. A second review in November 2012 ascertained whether performing chart review improved residents' practice behaviors.
  
  
  
  Initially, the least-square (LS) mean number of LRs without documentation of follow-up per resident in the self-, peer-, and self- + peer-review group was, respectively, 0.5 (SD 1.0), 1.0 (SD 1.7), and 0.9 (SD 1.3), and post intervention, this was 1.0 (SD 0.2), 0.3 (SD 0.2), and 0.6 (SD 0.2) (self- versus peer-review P = .03). Initially the LS mean follow-up time per resident in the self-, peer-, and self- + peer-review group was, respectively, 4.2 (SD 1.2), 6.9 (SD 1.4), and 5.9 (SD 1.2) days, and after the intervention, LS mean time was 5.0 (SD 0.5), 2.5 (SD 0.6), and 3.9 (SD 0.5) days (self- versus peer-review P < .01). Self-review was not associated with significant improvements in practice.
  
  
  
  In this comparison of self- and peer-review, only residents who performed peer-review demonstrated significant improvements in their documentation practices. These findings support the use of resident peer-review in improving LR follow-up, and potentially, in other, broader resident quality improvement initiatives.
authors.affiliation: A.J. Hale is clinical fellow, Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. R.W. Nall is assistant professor, Department of Medicine, Division of General Internal Medicine, University of Florida, Gainesville, Florida. K.J. Mukamal is associate professor of medicine, Harvard Medical School and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. H. Libman is director of ambulatory residency training, Department of Medicine, Beth Israel Deaconess Medical Center, and professor of medicine, Harvard Medical School, Boston, Massachusetts. C.C. Smith is associate professor of medicine, Harvard Medical School, and director, Internal Medicine Residency Training Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts. S.B. Sternberg is administrative director of quality improvement, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. H.S. Kim is assistant professor of medicine, Harvard Medical School, and faculty physician, Healthcare Associates, Beth Israel Deaconess Medical Center, Boston, Massachusetts. G. Kriegel is assistant professor of medicine, Harvard Medical School, and director of quality improvement, Healthcare Associates, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hale
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Nall
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.forename: Howard
authors.initials: H
authors.lastname: Libman
authors.forename: C Christopher
authors.initials: CC
authors.lastname: Smith
authors.forename: Scot B
authors.initials: SB
authors.lastname: Sternberg
authors.forename: Hans S
authors.initials: HS
authors.lastname: Kim
authors.forename: Gila
authors.initials: G
authors.lastname: Kriegel
mesh_terms: D000359:Aftercare / Q000592:standards* / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D001900:Boston; D002983:Clinical Competence / Q000706:statistics & numerical data*; D064790:Clinical Laboratory Services; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000592:standards* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018024:Peer Review, Health Care; D015397:Program Evaluation; D012647:Self-Assessment