Peer Review in Paediatric Endocrinology
Self Assessment Questionnaire
Centre:
Date:
Visitors:
12/02/16
Explanatory Notes
Introduction
The need for Peer Review of UK endocrine units was agreed by the Clinical
Committee of the BSPED in 2011. The Committee recommended that a series of
voluntary external visits be piloted. The project is clearly relevant to the agendas of
Clinical Governance in Endocrinology, Consultant Appraisal and Consultant
Revalidation. Other representative bodies (for example British Thoracic Society1,2 ,
British Renal Association 3 and Cystic Fibrosis Trust 4) have successfully undertaken
such schemes.
Purpose
The main purpose is to improve services for paediatric endocrine patients. Visits will
focus on basic standards of paediatric endocrine care and service provision. Visits
will form the basis for an exchange of ideas and experiences, and allow areas of
concern to be voiced.
Proposed structure
A visit will be made over one day by two consultants from different areas of the UK,
one of whom will be based in a district general hospital. As the project develops,
consideration will be given to the inclusion of nursing and patient members in the
visiting team. A separate document (‘Planning a Peer Review Visit’) contains
recommended timetables and templates for a visit.
Visit Report
The visit report will highlight examples of endocrine excellence, matters for
consideration and recommendations for change. The report ought to provide a
powerful lever to support local improvements (for example, to highlight a need for
consultant expansion). The report will be supportive, rather than punitive, but will
highlight any problems. Those reviewed will have an opportunity to correct any
factual inaccuracies in a draft version of the report. The report will be confidential,
and the final version will sent to the BSPED Peer Review Officer, and to no other
party without the express permission of the consultants reviewed. Those reviewed
will have the opportunity to provide feedback on the review process to their
reviewers. The reviewers will also be sent a feedback questionnaire.
Peer Review visits across the UK
These PR documents are adapted from the SfE Adult Endocrinology Services Peer
Review documents, developed over several years. They are based on the UK
Standards for Paediatric Endocrinology produced in 2010. The plan is to conduct a
comprehensive review of all UK Paediatric Endocrine Units over the coming years.
Conclusion
It is vital the BSPED is active in Clinical Governance. No nation-wide scheme
currently exists for our speciality, although the process is also just being developed
for Paediatric Diabetes. Such a scheme presents an opportunity to improve patient
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care, gain additional resources for service provision and to lift morale within the
paediatric endocrine community.
References
1.
Page RL, Harrison BDW. Setting up Interdepartmental Peer Review. Journal
of the Royal College of Physicians of London 1995; 29, 319-324 (www.britthoracic.org.uk)
2.
Page RL, Harrison BDW. Interdepartmental Peer Review. British Medical
Journal 1997; 314, 765-766
3.
Cameron J.S. Treatment of adult patients with renal failure. Recommended
standards and audit measures. 2nd Edition. Royal College of Physicians 1997
(www.renalreg.com)
4.
Standards for the clinical care of children and adults with cystic fibrosis in the
UK 2001. CF Trust 2001
(http://www.cftrust.org.uk/aboutcf/publications/consensusdoc/C_3000Stan
dards_of_Care.pdf)
5.
UK Standards for Paediatric Endocrinology 2010. www.bsped.org.uk
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Action
Please complete the Self Assessment Questionnaire as fully as possible. It may be
possible for the local Business Manager and his/her administrative team to enter the
activity data and other factual details, in collaboration with the Lead Clinician for
Endocrinology.
The completed Questionnaire should be sent to the Reviewers at least 4 weeks
before the visit so that pre-visit planning can be undertaken. It will not be possible to
visit all ‘feeder’ DGHs because of time constraints. However, following local
consultation, consultants from one DGH site will be invited to attend the main site
visit to contribute formally to the review process.
Importantly, please assemble the supporting documentation which may include
some or all of the following:
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Endocrine Unit handbook
Protocol sheets
Patient Information sheets
Shared Care documents (eg GnRH agonists, GH)
Commissioned surveys (eg clinic appointment waiting times, letter turnaround,
MRI/DEXA waiting times)
Recent Endocrine Audit reports
Unit Research summary
Web site URLs if appropriate
These supporting papers can be given to the Reviewers on the day of the visit.
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Pre-visit Questionnaire
Section 1: GENERAL INFORMATION ABOUT YOUR REGION/DISTRICT
What is the population of your Region or
District?
Does your Region or District have any
particular characteristics (social deprivation,
preponderance of ethnic minorities, rural
access problems etc)?
How many hospitals provide paediatric
endocrine services within your Region?
district?
List and Name all hospitals:
 Teaching
 District General
How many paediatric endocrine consultants
are there in your centre? Please give names
and indicate the number of hours per week
each individual allocates specifically to
paediatric endocrinology (not including general
paediatrics or Diabetes)
a) .
b)
c)
d)
e)
f)
g)
How many paediatric diabetes consultants are
there in your centre? Please give names
h)
i)
j)
k)
l)
m)
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Section 2: OUT PATIENTS
Out Patient Workload
(Please use separate sheets if necessary)
Number of Paediatric Endocrine New Patients
seen annually in your centre
If possible please give a breakdown for
different sub-speciality clinics
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Growth
Turners
General endocrinology
Disorders of sexual development
Adolescent/Transitional
Late Effects of childhood cancer
Metabolic Bone
Thyroid
Other
Number of Endocrine Review Patients seen
annually in your centre
If possible please give a breakdown for
different sub-speciality clinics
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Growth
Turners
General paediatric endocrinology
Disorders of sexual development
Adolescent/Transitional
Late Effects of childhood cancer
Metabolic Bone
Thyroid
Other
Number of Endocrine Day Cases seen
annually in your Investigation Unit
What is the waiting time for New Patients?
 Urgent
 Non-Urgent
Are there shortages of appropriately timed
Review appointments for any of the endocrine
clinics?
Please specify (giving as much detail as
possible)
What is the average time between receipt of a
referral letter & an appointment being issued?
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Are the clinics dedicated to Paediatric
Endocrinology or mixed General Paediatrics &
Endocrinology?
Out Patient Staffing & Clinic Support
Do you consider there are sufficient
consultants for the endocrine out-patient
workload?
Are any clinics regularly held in the absence of
a consultant?
Are there sufficient junior medical staff to help
with clinics?
Are they provided with written guidelines for
investigation & management?
Are there sufficient nursing staff to run the
clinics efficiently?
Is there a Paediatric Specialist Endocrine
Nurse?
Does a PSpEN participate in routine out patient
clinics?
Are your secretarial facilities adequate?
What is the average ‘dictation to typing’
interval?
(Please attach results of any recent surveys?)
What is the average ‘dictation to dispatch’
interval?
(Please attach results of any recent surveys?)
Is electronic communication used?
 Endocrine out patient referrals
 Clinic letters to referring clinicians
 E-mail consultations with GPs
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Out Patient Facilities
Do you have a dedicated Endocrine clinic area
or are clinics held within a general out patient
facility?
Is there a stadiometer in clinic? Is it correctly
placed? Is it frequently calibrated?
Is there a set of ‘heavy duty’ scales in clinic?
Are there facilities for venesection?
Are there facilities for cold-spinning blood
samples or for rapid specimen transport to the
endocrine laboratory?
Are there sufficient consulting rooms and
examination rooms?
Are there adequate X-ray viewing boxes/
access to PACS in the consulting rooms?
General Points on Out Patients
Are the clinics generally well-run and efficient?
If not, what are the main problems?
Do patients have any endocrine blood tests
before seeing the doctor?
Is there a supply of local leaflets about various
endocrine conditions?
Is there a supply of leaflets about the Child
Growth Foundation, Turner Syndrome Support
Society and other Endocrine self-help groups?
Are patients given written instructions on how
to manage their condition?
Who decides whether or not patients who
have not attended should be sent further
appointments?
Are post-clinic case discussion meetings held?
If so, what are the main objectives of such
meetings?
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Section 3: IN PATIENTS
In Patient Workload
What is the total number of paediatric endocrine
admissions annually in your centre?
What is the total number of endocrine
consultations annually (for in-patients in other
wards in your centre)?
Is there a specialist on-call rota for paediatric
endocrinology?
If so, what is the on-call frequency?
How often are the consultants on-take for
General paediatrics?
In Patient Staffing
Are there sufficient consultants to support the
in-patient workload?
Are there sufficient junior doctors to support
the in-patient workload?
Are there sufficient middle-grade staff
available to provide continuous specialist cover
for endocrinology?
Is the ward staffed adequately with nurses,
PAMs & support staff?
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In Patient Facilities
Are all paediatric endocrine patients admitted to
a dedicated ward?
Do patients with endocrine problems as part of
another diagnosis get referred quickly to the
paediatric endocrine team (eg neuro-oncology
patients, PICU patients)?
Is there a ‘high dependency’ area in the ward (or
hospital) for patients with severe metabolic
problems?
Are the imaging facilities easily accessible?
Is the ward well run and efficient?
Are results from investigations available on the
same day as requesting (eg cortisol, thyroid
function tests)
Secretarial Support and Facilities
Does each consultant have at least 1 WTE of
secretarial support?
Is there sufficient secretarial support for the
clinical needs of the department?
Is there sufficient secretarial support to service
the additional demands of education and
research?
Are the IT infrastructure & support satisfactory?
Endocrine Testing/Day Cases
Is there a unit for Endocrine Investigation?
Is it staffed by Specialist Endocrine Nurses?
Is the Unit adequately staffed?
Is there an up to date Endocrine Handbook?
Are there resuscitation facilities?
Is there a waiting list for endocrine
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investigations?
If so, what is the current waiting time for routine
tests?
Chemical Pathology/Endocrinology
Is there a chemical pathologist who specialises in
endocrine biochemistry?
Are there regular meetings with chemical
pathologists?
Are the turnaround times adequate for routine
hormone assays (eg. cortisol, thyroxine and
prolactin), as clinical need dictates?
Are the arrangements adequate for
Supra-Regional endocrine assays?
Does the local laboratory participate in NEQAS?
Are there any particular investigation problems
or limitations to highlight?
For example
 Is the local TFT strategy satisfactory?
 Is there access to SHBG or free testosterone
assays?
Imaging Facilities
Is there a MRI scanner?
What is the waiting time for ‘routine’ pituitary
MRI?
Are there facilities for bone densitometry?
What is the waiting time for DEXA?
Are facilities for radionuclide scans satisfactory?
What is the waiting time for a radionuclide scan?
Are facilities for ultrasound satisfactory?
What is the waiting time for USS?
Are the images number coded?
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Is there a PACS system? Does it link easily with
other hospitals in the region?
Is there a radiologist with a special interest in
endocrine radiology?
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Section 4: SPECIALIST CLINICS
Are multidisciplinary, specialist clinics held for
certain groups of patients?
For example:
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Disorders of sexual development
Turner’s syndrome
‘Late Effects’ of Childhood Cancer
Transition clinics
Renal/endocrine clinics
Metabolic Bone Disease
Neuroendocrine Tumours
Endocrine Genetics
Others (please give details)
Section 5: TRAINING
Consultants
Are the consultants able to keep abreast of
developments in Endocrinology by attending
local,regional and BSPED meetings?
Are the consultants able to fulfil their CPD
requirements?
Junior Medical Staff
Does the unit hold regular formal ‘topic teaching’
meetings for junior staff?
Does the Unit have written policy documents on
various conditions?
Are adequate IT & library facilities available onsite?
Are specialist registrars encouraged to undertake
‘endocrine consultations’ around the hospital?
If so, how are their opinions ‘checked’?
Are the juniors encouraged to undertake
research or write case reports?
Are the juniors able to take study leave?
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When was the most recent School of Paediatrics
training inspection?
Nursing Staff
Does the unit hold regular training sessions for
nurses?
Section 6: RESEARCH
Is the unit active in research?
If so, please provide the unit research summary
If not, is this because of lack of staff, time or
resources?
Are the juniors encouraged to undertake
research?
Section 7: AUDIT
Does the unit regularly audit its activities?
If so, please give examples of recent audit reports
Does the unit maintain an endocrine diagnostic
database?
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Section 8: MEETINGS
Does the unit have regular specialist meetings?
Does the unit have regular radiology meetings?
Does the unit have regular meetings with a
clinical biochemist?
Is there any formal liaison with surgeons to
discuss cases?
Are there any regular regional meetings?
Section 9: RELATIONSHIPS WITH OTHER DEPARTMENTS
Are there any special links with particular
consultants in other departments such as:
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Paediatric urology/ gynaecology
Adult endocrinology
Neuro/pituitary surgery
Radiotherapy
Psychology/psychiatry
Nuclear Medicine
Thyroid surgery
Ophthalmology
Are any of these links unsatisfactory?
Are any of these activities performed in other
hospitals?
If so, does this present any particular problems?
Are the links with Primary Care satisfactory?
Do ‘shared care’ arrangements work well?
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Section 10: MEDICAL RECORDS
Are these satisfactory?
Are there difficulties in locating notes for out
patient clinics?
Is there a flow sheet for serial results?
Section 11: BUDGET HOLDING
Does the unit have its own budget?
Are there any problems with this?
Are there problems with funding of expensive
endocrine therapies such as GH & IGF-1?
If so, how many hours per week does the Lead
Clinician have to spend on these negotiations?
Section 12: LOCAL PERCEPTIONS FOR CHANGE
What are the changes most wanted by the
endocrine unit?
How would they like the endocrine unit to be
developed?
Does this relate to any of the local NHS priorities
for change?
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