Advanced Practitioners Are Peers in Trauma Performance Improvement Peer Review

Area of Science:

• Trauma Surgery
• Healthcare Quality Improvement
• Patient Safety

Background:

• Advanced practitioners (APs) are increasingly integrated into clinical care for injured patients.
• The expanding role of APs in trauma care necessitates evaluating their capabilities in quality improvement processes.

Purpose of the Study:

• To hypothesize and evaluate if APs can perform Performance Improvement and Patient Safety (PIPS) peer reviews comparable to trauma surgeons.
• To assess the concordance between APs and trauma surgeons in reviewing medical records for PIPS.

Main Methods:

• Phase 1: Retrospective review of previously surgeon-reviewed cases by APs, comparing their assessments.
• Phase 2: Concurrent, blinded peer review of cases by both APs and trauma surgeons (MDs).
• Both phases compared concordance on appropriateness of care and preventability of mortality.

Main Results:

• Phase 1 showed high concordance (96.0%) between APs and surgeons on care appropriateness (κ = 0.774) and (95.5%) on mortality preventability (κ = 0.861).
• Phase 2 demonstrated high concordance (89.0%) on care appropriateness (κ = 0.585) and (86.2%) on mortality preventability (κ = 0.266).
• APs were more likely to identify care as inappropriate when disagreements occurred.

Conclusions:

• Advanced practitioners demonstrate high concordance with trauma surgeons in medical record reviews for PIPS.
• APs are capable of effectively reviewing medical records for Performance Improvement and Patient Safety purposes.
• This validates the integration of APs into quality improvement and patient safety initiatives within trauma care settings.