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Quality Practice
Volume 12 No 3
I
June 2016
23
Radiologists are required to provide
diagnostic support in a timely manner
to help improve the care of patients. On
occasion, due to error or the subsequent
presence of additional information,
retrospective review may lead to a
differing opinion than that expressed
in the original report. Systems that
minimise the risk of error, and a system
to help minimise repetitive error, have
the potential to improve the quality and
safety of the medical imaging services
we deliver.
Peer review meetings have become
a compulsory part of continuing
professional development and
revalidation within the UK. The Royal
College of Radiologists formally
proposed peer review meetings in 2001
1
,
and subsequently produced educational
and governance objectives in 2007
2
and
have since published
Quality assurance
in radiology reporting: peer feedback
in 2014
3
. This publication proposed
that “all departments should aim to
implement systematic review of 5% of
reports by 2018”.
3
In the UK, the name
of the meetings has recently changed to
Learning from Discrepancies Meetings
(LDMs) to reflect the main focus of the
meeting.
The opportunity for peer review
may occur through three avenues:
during routine work (reporting/MDT
preparation); as part of a systematic
review of reports, wherein a radiologist
will be given a number of cases to
review per month; or following review
by a medical practitioner from another
speciality.
A system should be devised to allow a
discrepancy that one would not want
to occur in future to be fed back to the
original reporter. A regular departmental
meeting can then provide the medium
to share these learnings. To set up such
a meeting, several principles need
consideration:
1. The environment needs to be non-
threatening and non-judgemental.
The key to this is to run an
anonymous meeting, with patient
identifiers, referring clinician and
reporting doctor not disclosed. The
meeting should not be a test for
observers, but rather a vehicle for
case discussion in the hope that the
learning episode will decrease the
chance of the same error occurring
again. Calculating error rates and the
use of grading systems have been
shown to be counter-productive and
are not recommended.
4,5
2. Following the meeting, a short
PowerPoint presentation could be
made with screenshots to email to
all those in attendance, and those
that were not able to attend, to
summarise the learning points.
3. By involving as many as possible,
rather than just individuals we are
striving to improve performance
via the modern approach to the
performance curve.
6
The major impediment to
implementation of a routine peer review
/discrepancy meeting system is the time
involved in setting up a discrepancy
notification system and organising the
materials for the meeting. Without
administrative support and a team
effort, such meetings can easily lose
momentum over time. A novel method
of peer review has recently been trialled
in the UK of loading cases for review
onto a database. Radiologists were
given a three-week period to review the
cases. This method showed significantly
higher participation than traditional
discrepancy review meetings and also
elicited positive feedback.
7
As medical specialists, we are always
striving to improve patient care through
technological innovation and research.
Learning from our mistakes is crucial to
improve patient safety.
Dr Simon Prowse
Peer Review
– A Learning Opportunity Not To Be Missed
References
1. To err is human: the case for review of
reporting discrepancies. The Royal College of
Radiologists, 2001.
2. Standards for Radiology Discrepancy
Meetings. London: The Royal College of
Radiologists, 2007.
3. Standards for Learning from Discrepancy
meetings, London: The Royal College of
Radiologists, 2014.
4. Eisenberg RL, Cunningham ML, Siewert
B, Kruskal JB. Survey of faculty perceptions
regarding a peer review system. J Am Coll
Radiol. 2014 Apr;11(4):397-401. Epub 2013.
5. Prowse SJ1, Pinkey B, Etherington R.
Discrepancies in discrepancy meetings: results
of the UK national discrepancy meeting survey.
Clin Radiol. 2014 Jan;69(1):18-22.
6. Larson DB1, Nance JJ. Rethinking peer
review: what aviation can teach radiology about
performance improvement. Radiology 2011
Jun;259(3):626-32.
7. Carlton Jones AL, Roddie ME. Implementation
of a virtual learning from discrepancy meeting:
a method to improve attendance and facilitate
shared learning from radiological error. Clin
Radiol. 2016 Feb 27 (epub ahead of print).