Peer Review in Paediatric Endocrinology
Visit Report
Centre:
Date:
Visitors:
1
1. Introduction
Brief details of district size, number of hospitals involved, consultant staffing levels,
workload and overall provision of paediatric endocrine services.
 The staffing/workload details should be specific and summarise the total number
of consultant hours per week devoted to endocrinology & the numbers of new
and review patients seen annually by the unit.
 Any special demographic characteristics (eg. urban/rural balance, social
deprivation etc) should be highlighted.
 A map of the region would be helpful.
2
2a. List of those interviewed
Consultants
Specialist Registrars
Specialist Endocrine Nurses
Management Representatives
Secretaries
Patients (anonymised details of patient ‘type’ & interview setting)
Others
3
2b. List of key individuals in the unit not interviewed
Consultants
Specialist Registrars
Specialist Endocrine Nurses
Management Representatives
Others
4
3. Departments visited
Hospitals
Departments visited
(eg.
PIU, endocrine ward, endocrine outpatient clinic, seminar
rooms, biochemistry labs etc)
1.
2.
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4. Documents reviewed
Document
Comments
Peer Review - Self Assessment
Questionnaire
Brief description of Endocrine
Unit
Endocrine Unit Protocols
Handbook
Patient Information leaflets
PIU day case documents
Shared Care protocols
Hospital Case Notes
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5. Standards for Endocrine Care
Commentary should be provided on each of the Basic Standards for Paediatric
Endocrine Care approved by the Clinical Committee of the BSPED in 2011 and the
RCPCH specialist services definitions in 2010. The following Reviewer Gradings will
be given for each criterion.
GRADING OF ENDOCRINE
STANDARD
GRADING ABBREVIATION
(IN REPORT)
DEFINITION
MET
M
Evidence or information
which shows the criterion is
being met
EXCEEDED
Exc
Very good practice
UNMET
UnM
Evidence or information
which shows the criterion is
not being met
NO SUPPORTING EVIDENCE
N.S.E
No supporting evidence
provided by the visited
endocrine unit
NOT APPLICABLE
N/A
Criterion not applicable to
this endocrine unit
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Standard 1: Access to Specialised Paediatric Endocrine Services
Standard Statement: Waiting times should be as short as possible and tailored to the
clinical urgency. A senior endocrine opinion should be provided at the first clinic visit.
Availability of endocrine investigations and specialist opinion within an acceptable
time.
Rationale: All children identified with an Endocrine health disorder need to have
access to high quality, evidence based care provided by suitably trained multidisciplinary teams.
Essential Criteria
1.
Endocrine referrals should be
prioritised by a Consultant as soon
as possible after receipt2
2.
Urgent appointments should be
offered as soon as possible and
non-urgent appointments within an
acceptable timescale3
3.
Patients should be seen by a
Consultant, SpR or post-MRCP SHO.
All new patients seen by trainees
should be discussed with a
consultant. No new patients should
be seen in clinics where a
consultant is not in attendance.
4.
There should be access to ‘basic’
out-patient measurements &
investigations (eg. stadiometer,
venepuncture, X-ray)
5.
Patients should be investigated &
managed according to written
protocols and care pathways.
Availability of shared care protocols
6.
Telephone access to consultant
endocrine advice is available for
staff in secondary care 24 hours a
day
Availability of transition clinics for
young people with endocrine
disorders to transfer to adult care
Access to urgent MRI is available
and reported on by a paediatric
radiologist within 24 hrs
Non urgent MRI scans are available
and reported on by a paediatric
radiologist within 12 weeks
7.
8.
9.
Comments
Grade
8
10. Radiology services can determine
and report bone ages
11. Specialist psychology support
should be available for all patients
who require it, in particular for
those children and young people
(and their family) with disorders of
sexual development
Desirable Criteria
1.
Systems for electronic referral
should be developed. Electronic
booking of out-patient
appointments. A system of
‘electronic consultation’ with
primary care might obviate the
need for some clinic referrals
2. Availability of multidisciplinary clinics
and outreach services
3. Availability of specialist
gynaecological opinion at lead centre
4. Availability of routine and complex
endocrine biochemical investigations
5. Pelvic ultrasound scanning is available
and reported on by a paediatric
radiologist within 12 weeks
6. Isotope scanning eg thyroid and bone
is available at lead centre
7. DXA scans undertaken by staff with
expertise in children – reports available
within 12 weeks
8. Post-clinic case discussion meetings
are commended for both quality
assurance & education
Referral prioritisation2
Very good practice
Acceptable
Unacceptable
Within 5 working days
(WDs)
Within 10 WDs
Longer than 10 WDs
Appointments3

Urgent
Within 2 weeks
Within 6 weeks
Longer than 6 weeks

Non-Urgent
Within 2 months
Need to reflect current
government targets here
Ditto



Attainment on >90% of occasions secures a particular category
‘Hard data’ from Endocrine Unit management are essential to validate the grades awarded
Reviewers to shade categories achieved
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Standard 2: Resources of Specialised Paediatric Endocrine Services
Standard Statement: There should be adequate staffing and resources for the
appropriate delivery of specialist paediatric endocrine care across the network.
Rationale: Paediatric endocrine services are adequately staffed with appropriate
multi-disciplinary professionals who are fully equipped to deliver equitable care
across the network. These staff are supported by other essential resources to deliver
this care safely and effectively..
Essential Criteria
Comments
Grade
1. There is a fully resourced multidisciplinary team in the lead centre
which includes:
Paediatric Endocrine Nurses
Psychology
Clinical Geneticist
Paediatric Surgery & Urology
Adult Endocrinologist
Adolescent Gynaecologist
Data Clerk
2. There is co-location with other
specialist services which includes:
Neurosurgery
Oncology
Critical Care
Cardiology
Nephrology
3. High cost therapies should be
funded provided they are
recommended by a consultant
endocrinologist using evidence-based
guidelines and shared care
protocols
4. Play specialists are available in all
appropriate areas of the service
5. Adequate time for all staff to
undertake study leave, attendance at
MDT meetings, CPD and mandatory
training
Desirable Criteria
1.
An information system should be
maintained which contains a
minimum dataset of demographic
details and endocrine diagnoses
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2. Mechanisms are in place to allow for
year on year growth and service
development
3. Turnaround times for the majority
of
biochemical investigations should
be less than 2 weeks
11
Standard 3: Environment and facilities, care of the child and
family/patient experience
Standard Statement: The environment and facilities should be appropriate for the
age and developmental needs of the child.
Rationale: All children and young people are cared for in a child friendly
environment with suitable facilities and equipment for their age and developmental
needs
Essential Criteria
Comments
Grade
1. Patients should be provided with a
clear explanation of their condition
and any treatment, investigation or
procedure proposed, including risks
and alternatives, before agreeing on a
particular course of action, to enable
them to give informed consent1.
2. Where appropriate, patients should
be provided with jargon-free and
easily understood information
materials which reinforce criterion 1.
For example, locally produced leaflets
on thyroid disorders or pamphlets
from patient organisations such as
the Child Growth Foundation or the
Turner
Syndrome Society
3. Families are provided with contact
details for appropriate support
groups
4.. Facilities for day case endocrine
investigations are available at the
lead centre
5. Provision of appropriate outpatient
and inpatient facilities for adolescents
Desirable Criteria
1. Information and support is given
to parents and families on how to
access funds to travel to and from
a specialist centre where necessary
2. Transition pathways are in place to
allow for seamless transition to adult
services
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3. When children and young people
require two or more specialist
services, effort should be made to coordinate care by a key worker
1
This is clearly difficult to assess during a peer review visit, but all PRVs should include some opportunistic
interviews with patients in a routine clinic or endocrine investigation unit
13
Standard 4: Communication
Standard Statement: There should be prompt transfer of detailed information
following out-patient and in-patient endocrine assessments.
Rationale: There is effective two-way communication from local to specialist care
and back and between professionals and children, young people and their families
Comments
Essential Criteria
1.
Letters should contain a list of
principal & other diagnoses,
together with a list of
recommended medications and
their doses
2.
Letters should be typed and posted
as soon as possible after an episode
of endocrine care1
3.
Availability of contact telephone
numbers for emergency advice
Patients and their families and
health professionals have access to
clear instructions and
consultant/specialist nurse advice
during routine working hours
4.
Grade
Desirable Criteria
1.
Systems for electronic
communication should be
developed
Patients and families have the
opportunity to contribute to a patient
satisfaction process
3. Development of the role of the
specialist endocrine nurse is invaluable
in the provision of endocrine
information
4. Guidance should be provided to
patients and their families regarding
useful and reliable internet websites for
provision of endocrine information
5. Creation of a unit website should be
considered with appropriate links to
national and international
organisations
Time to Letter Posting1
Very good practice
Within 10 working days
(WDs)
Acceptable
Within 15 WDs
Unacceptable
Longer than 15 WDs
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

Attainment on >90% of occasions secures a particular category
Surveys necessary to provide valid data (‘time to typing’ is easy to measure but ‘time to posting’ is more
difficult)
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Standard 5: Clinical Governance, Professional Education and Training
and Evidence Base
Standard Statement: All staff should be appropriately trained, undertake continuing
professional development and deliver evidence based care.
Rationale: Endocrine services are staffed with appropriate multi-disciplinary
professionals who are fully trained and supported to maintain their continuing
professional development. High quality evidence based care is used when available
Essential Criteria
Comments
Grade
1. Evidence of specialist endocrine
training and CPD of medical and
nursing staff
2. All paediatric endocrine medical and
nursing staff should have safeguarding
training
3. Endocrine units should undertake
regular audit of compliance with
pathways and protocols and treatment
outcomes
4. Existence of an induction programme
for new members of staff
5. Clinical pathways, protocols and
guidelines are developed as part of
the managed clinical network (MCN)
6. Multi-disciplinary research is an
essential component of the MCN
Desirable Criteria
1. Consideration should be given to
enrolling patients in multicentre
studies of clinical effectiveness &
safety
2. Participation in national databases
should be encouraged1 eg the GH audit
and Turner Register
3. Lead centre is an accredited training
centre
4. The MCN should produce an annual
clinical governance report
1
Patient consent is essential if data are sent outwith the centre
.
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6. Conclusions and Recommendations
Major Strengths of the Endocrine Unit and
examples of Good Endocrine Practice
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Points for Consideration
Recommendations
Main Points
Other Points
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Confidentiality
This preliminary report is confidential and those reviewed will have an early
opportunity to correct any factual inaccuracies. The final version will go to the BSPED
Coordinator for Peer Review and to no other party without the express permission
of the consultants reviewed. In turn, those reviewed will have the opportunity to
provide feedback on the review process to their reviewers.
Signatures
First Visitor
Name:
Signature
Date:
Second Visitor
Name:
Signature
Date:
Record of thanks
(to the lead organisers in the centre visited)
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