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PSA Friend or Foe discussion highlights: Part 3

21 Jul 2019

Your hot topic questions answered in final report

By: Jennifer Williams, MD; Jefferson Loa, MD; Chris Clarke, MD and Sara Horn, CNO

Thank you for attending the April 10 town hall about Salem Health’s patient safety alert system and our peer review process. If you missed it, here is the PowerPoint presentation.

Q: Why can’t there be direct face-to-face communication with physicians about concerns, especially the minor and quickly solvable issues, which could help patient care in real time, rather than reporting through our somewhat cumbersome PSA & peer review system?

This type of verbal reporting and problem solving system does exist and works well within some of our more cohesive units such as the ICU and ED, but doesn’t function well across different units, disciplines, specialties, floors, etc. or in areas where many different physicians come and go, sometimes sporadically. There are many reasons why verbal reporting doesn’t happen in these settings, not the least of which is that nurses often don’t know to whom to report their concerns; they rarely see the physician on the unit or don’t know how to contact them. Also, nurses may feel intimidated confronting some physicians with a question or concern. As within any organization for which safety is of paramount importance, reporting is highly encouraged.

Sarah Horn, CNO, described nursing leadership’s efforts to have face-to-face discussions with physicians about concerns that generate PSAs. Standard work was developed, but, as with all new efforts, culture change takes time. These discussions have been very helpful clarifying and resolving problems resulting from miscommunication or misunderstandings.

Q: Is there a process for providing feedback to correct misunderstandings about standard of care or other clinical issues to those who submit PSAs?

There is a process to share feedback with those who file PSAs. However, this system could be improved upon, and we’re working on a test of change to improve the delivery of feedback to those who report through the PSA system.

Q: Is there an ombudsperson for medical staff?

Dr. Austin, a member of the MPRC, explained that PSAs are evaluated, reviewed and processed by physicians, and peer review and credentialing processes are led and managed by committees made up of physicians. While there may be other ways to address PSAs, medical staff leadership now works closely with hospital leadership to ensure fairness and consistency.

Q: What’s the difference between a PSA and a patient complaint?

Patient complaints or grievances are submitted by patients or their family members and are managed according to a highly regulated process by patient advocates. This process is separate and distinct from the peer review process, and may work in parallel to resolve the same issue.

Patient complaints can be filed and responded to while the patient is an inpatient. Patient grievances filed after the patient is discharged require a different response process from the patient complaint response.

Q: Why can’t “zero” or “no issue” PSAs just disappear?

The MPRC feels it’s important to track all PSAs, even “zeros,” since those which individually may seem inconsequential might cumulatively suggest a pattern of concerning incidents over time. These PSAs are not seen by the Credentialing Committee at reappointment.

All PSAs are logged into the RL software system, which is protected by ORS 41.675.

Q: Someone said that they had three “zero” level PSAs which resulted in a one-year (rather than full two-year) reappointment.

This is not possible. The Credentials Committee does not see “zero” PSAs and therefore cannot factor them into determining reappointment terms. There are times when a shorter reappointment period is assigned, but this is related to other issues.  

Q: Some specialty practices carry a higher risk of morbidity and mortality, and therefore will have more PSAs filed if all bad outcomes or complications are reported. How is this handled?

MPRC strives to make the peer review process as fair and consistent as possible across all specialties. The MPRC is made up of practicing physicians who are well aware that known complications will happen, in some specialties more than others. Generally these are treated as “zero” reports, tracked only internally within the peer review system. Occasionally the specialty section chief will request peer review of a complication to explore educational opportunities for improving patient care.

Please email with any questions.