External Peer Review as a Tool for Risk Management

There are a number of risks associated with poor peer review. The number one risk is the development of a punitive culture where reviewers feel that they are not being asked to assess a fellow practitioner, but rather to punish him or her. Poor peer review can also lead to poor quality, the loss of reputation or competitive positioning, high malpractice costs, and expensive litigation. Government audits can also result and payments may be withheld in situations in which care did not meet the appropriate standards.

An effective peer review program is a key risk management tool for leading hospitals and ambulatory surgery centers. High quality care cannot be ensured without an effective peer review program. Patient safety depends on not only the physicians and the nursing staff, but also every person who works in the healthcare facility, including those in risk management and medical staff offices, all of whom are involved in credentialing, monitoring, and peer review.

There are many best practices related to peer review. One of the most important is risk avoidance through prevention. A good peer review process does not just involve the isolated review of sentinel events, which is reactive. Instead, it takes a proactive approach and involves systematic review, which is the regular assessment of the highest risk specialties and the establishment of an external peer review program to complement and strengthen internal peer review.

Very high-risk specialties should undergo ongoing external peer review. These specialties include cardiology, neurosurgery, obstetrics and gynecology, emergency room, cardiovascular, surgery, general surgery, radiology, and anesthesiology.

Ongoing external peer review facilitates the assessment of these high-risk specialties and reduces medical errors, adverse events, and malpractice costs over time. Case reviews and practitioner follow-up must be timely and external peer review must be used consistently to avoid punitive stereotyping. Peer review must not be viewed as punitive, but rather as an opportunity for learning from past mistakes so that they are not repeated in the future.

The process of peer review should serve to continuously improve both the system and the care being provided to patients. External peer review plays an integral part in managing and mitigating risks, decreasing conflicts of interests, reducing medical errors, and lowering malpractice costs and the risk of litigation for hospitals and ambulatory surgery centers.