And now that Canadian Family Physician is free fulltext online from 2001,(html and pdf), you can go directly to: Appendectomies in rural hospitals Safe whether performed by specialist or GP surgeons S. Iglesias, MD L.D. Saunders, MD S. Tracy N. Thangisalam L. Jones at http://www.cfpc.ca/cfp/2003/Mar/vol49-mar-research-3.asp Lynn G. Dunikowski, MLS
Local experiences:
I think you need to look at this as a learning experience. There are two
things you learned: that you need to set up a system for reviewing cases that is
not specialty-specific, and perhaps you learned something about this surgeon.
I have had the privilege recently of organizing and chairing a perinatology QA
review here in Klamath Falls the last few years. The impetus was that the OBs
felt that some of the family doctors were too cowboy and that the OB nurses felt
that a couple of the OBs were behaving irresponsibly. We established a system
where anyone could report to our QI coordinator anything that occurred on the OB
floor that troubled them. They just had to write it up and sign it, but we did
protect the identity of the whistleblowers. Each case was then assigned to a
delivering FP, an OB, or a midwife for review. We meet every month and present
and discuss the cases. i arranged so that every OB provider: midwife, FP, or OB:
and also the pediatricians were committee members and set up a time people could
come so that no one felt excluded.
I think we have succeeded in developing an environment in which people can speak
frankly about their concerns regarding other people's practice or bizarre
behaviour and we view each one as a learning experience. Out discussions have
led to development of a list of when FPs and Midwive's must consult (graded 1
through 4 by don't need to consult up to have to) and have developed protocols
for VBAC, group B strep, etc. I think we have gotten through people's
insecurities and prejudices and established a fair degree of trust. It has taken
a lot of work.
If you have hospital administration at the meeting then the proceedings are
protected from discovery. So perhaps in this case you need to set up a written
protocol for colonoscopy, a method for handling complications, and a peer review
system
to look at them, even if it is only you looking at his and he looking at yours
in a regular meeting with hospital administration present.
Jim Calvert
Question about rural QA from FP who does surgery regarding complications and
improving Rural QA with local and visiting specialists plus FPs in the mix.
Quality in Rural Medical Education