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Outmoded Peer Review System Spells Trouble for Radiology

Most industries now examine systems, rather than individuals, for ways to improve performance. However, in a June 2011 article in Radiology, researchers reported that the American College of Radiology continues to rely on the outdated practice of peer review, a procedure that could put patients at risk for inadequate or unnecessary treatment and increase the risk of medical malpractice errors.

The Downsides of Peer Review Programs

In radiology's peer review system, radiologists examine peer reports for reading errors or misdiagnosis. Cincinnati radiologist David B. Larson and John J. Nance, JD, in CMIO.net say that most industry groups largely abandoned peer review programs in the 1980s because:

  • By coaching or judging someone, peer review efforts tend to be perceived as punitive, and often make individuals defensive.
  • Studies show that peer-review data are often subjective, inaccurate and biased, yet its quantitative presentation gives it a false impression of accuracy.
  • Peer review error reporting is often too simplistic, and implicitly labels some radiologists as good and some as bad.
  • Simply measuring and documenting errors doesn't improve performance, because it fails to identify the root of the problem and how to prevent a recurrence.
  • Linking errors to individuals disregards the role of the broader system-and research shows that an error made by one person is likely to be committed by others.

In addition, Larson and Nance indicate that, "Decades of research have shown that individual error rates derived from reporting systems do little by themselves to improve, or even accurately measure, individual performance."

Aviation Industry Led Push for Systemic Improvement

The most telling indictment of peer review practices was documented decades ago in the aviation industry. When TWA Flight 514 crashed in 1974, killing 92, experts first viewed it as a case of pilot error complicated by bad weather. After investigating further, officials recognized that the same error had occurred repeatedly due to a poorly designed aviation reporting system. A shift toward systemic improvement then transformed aviation from its high-risk status into a safe activity, with less than one fatal accident per nine million flights.

Process Improvement Enhances Radiology Performance

Recent efforts show that this systems approach can work wonders for radiology. According to HealthImaging.com, focusing on eliminating inefficient processes allowed Columbus Regional Hospital in Indiana to increase CT volume by 600 studies per month, cut exam time by 33 percent and grow CT reimbursements 34 percent -with fewer scanners and technologists.

Likewise, Akron Children's Hospital cut MRI waiting times from 28 days to three - while increasing weekly exams 25 percent and annual revenue by $1.3 million.