Best Practice Case Study: Systematic External Peer Reviews
A large hospital in the Midwest chose to comply with the Joint Commission’s requirement for “Ongoing Professional Practice Evaluations” and set up a process for that. To start, they revamped their internal and external peer review polices to meet both the language and intent of the new standards. Then the quality management staff set up a routine proactive peer review program for key practice areas, including interventional cardiology, radiology, anesthesiology and emergency medicine.
The medical staff decided on the number and frequency of the cases to be peer reviewed. Some of the cases would be selected based on specific criteria and others randomly. The quality staff wanted random reviews to comply with the Joint Commission’s requirement for ongoing reviews and to meet the hospital’s quality of care initiatives. They also felt that random selections would not single out any physician and reduce any worry regarding why a particular peer review was being done. The staff recommended an internal review of the cases first and then an external review when needed. The overview of their approach looks something like this:
Interventional Cardiology |
-staged procedures 4 cases per cardiologist per quarter |
Radiology |
-3 cases per quarter per radiologist |
Anesthesiology |
-2 random cases per anesthesiologist per quarter |
Emergency Medicine |
-3 random cases per emergency medicine physician per quarter |
This method of proactively and systematically reviewing cases both internally and externally (when needed) is becoming a Best Practice with leading hospitals who are committed to establishing higher levels of practitioner performance, transparency and accountability. It not only appropriately balances the responsibility of peer review between internal and external reviewers, but it documents the number of cases and frequency. It also sets the expectation for peer review as an ongoing process by the entire medical staff and lessens the anxiety about peer review singling out specific physicians. It emphasizes peer review as an educational process in the spirit of a hospital’s dedication to continuous improvement.