Abstract
Peer Review is the evaluation of professionals by a peer who practices in a similar role and scope of practice. Yale New Haven Hospital (YNHH) Medical Staff Office utilizes ‘The Joint Commission’ ongoing professional practice evaluation (OPPE) to conduct peer review for re-credentialing of all providers, following a traditional medical model. YNHH credentials more than 400 APRNs. The quality and depth of OPPEs varied by setting. The Chief Nursing Officer (CNO), the nursing representative on the Credentials Committee, recognized that APRNs were not involved in the process of review and APRN metrics were not incorporated into the evaluation as the historic tool had originally been developed for physicians. The CNO convened an APRN council to evaluate the current process and make recommendations for a more robust process. The APRN Council conducted a survey of credentialed APRNs to gain understanding of the needs of the group. The survey revealed that only 25 % of APRNs had reviews completed by another APRN. The remainder had evaluations done by physicians and administrators. APRNS expressed the need for increased participation in the review process, peer support, feedback and advocacy. APRNs indicated the need to integrate metrics that reflect the APRNs contribution to patient care and outcomes. The APRN council developed a Likert-like peer-review tool utilizing the 6 domains of competence outlined by The Joint Commission OPPE. The tool was to be completed by a peer, collaborating physician, and self. They would also be peer reviewed by the APRN and their manager. The documents were then to be submitted to the Medical Staff Office to be used in the re-credentialing process. The peer review process was piloted, over 6 months, in three divisions: Oncology, Heart and Vascular, and Certified Registered Nurse Anesthetist (CRNA) groups. APRNs, Medical Staff Office and CNO evaluated the process. Each felt the process provided a robust profile of the APRNs practice. Minor revisions of the tool were suggested including consolidating domain evaluation, chart review and goal setting onto a double side piece of paper. The new process was adapted and instituted for all divisions in the hospital. It will be incorporated into affiliated community practices. The development of a standardized tool and an integrated infrastructure assures that contributions of APRNs can be quantified and patient outcomes tracked. The new process provides an opportunity to promote self-regulation and improve upon the quality of care provided. Adoption of the process provides the ability to review common patient care themes, promote practice standards and stimulate APRN driven research initiatives.
