Abstracts

Rationale: In 2015 the Institute of Medicine (IOM) reported that diagnostic error contributes to 10% of patient deaths and 6-17% of adverse events in hospitals. The IOM recommended that health care systems “develop and deploy approaches to identify, learn from and reduce diagnostic errors and near misses in clinical practice” (from: Improving Diagnosis in Health Care. (2015). Balogh, Miller & Ball (Eds.). Washington (DC): National Academies Press. Previous authors have suggested that psychological safety, high quality relationships and group discussions are important prerequisites to learning from errors. The aim of this project was to develop and assess a peer-based quality improvement program for EEG reporting. Methods: Seven neurologists participated in a 12-month mandatory peer-to-peer EEG quality improvement project. Each neurologist re-read 4 randomly assigned EEGs per month. If they disagreed with the initial interpretation, they were instructed to provide structured feedback (PEQUIP) to the initial viewer. Irreconcilable differences were settled by an external third party. Concurrently, monthly EEG rounds were organized. After 9 months the neurologists answered questions to evaluate 1) the impact of the program on their ability to read EEGs, 2) the quality of relationships with their peers and 3) their sense of psychological safety. They also provided feedback regarding their perception of the main EEG quality reporting issue and recommendations to improve the peer review program and EEG rounds. Results: Between September 2017 and May 2018, 200 EEGs were reviewed by 7 neurologists. 3 PEQUIPs were generated and 1 EEG was sent for external review (Figure 1). An addendum to the EEG report was dictated in all 3 cases. 5 of 7 neurologists completed the entire survey and 1 neurologist completed 14/21 questions. There was a wide range of opinions about the program, but the most consistent result was that the neurologists felt comfortable reporting a difference of opinion. Overall, they rated the quality of relationships between EEG reviewers and psychological safety reporting EEGs as positive but the peer review quality improvement program as negative. Specifically, they felt the program was time-consuming and did not enhance their professional development. In a follow-up group interview, suggestions were made to improve the sensitivity of the peer review program by selecting EEGs that had been previously reported as being abnormal and to improve the educational value of EEG rounds by making them case-based and more accessible to all.  Conclusions: An EEG peer review program is a feasible, low-cost way to assess the quality of EEG reading, however, in our experience, neurologists did not feel that this initiative improved the quality of EEG reading. In non-selected routine EEGs, a difference in interpretation is rare. In order to promote the effectiveness of a peer review EEG program we suggest selecting EEGs to be reviewed and combining peer review with EEG rounds that are case-based and accessible to all.  Funding: No funding