The term “peer review” makes people think about picking up a chart, opening it, looking at the documentation, asking questions, and assessing it. However, peer review is much more. It is a truly professional review by a peer or body of peers that monitors both physician competence and professional conduct in order to promote the highest quality medical care and patient safety. A good peer review system includes both internal and external peer review to achieve these goals.
When To Utilize External Peer Review
CREDENTIALING AND PRIVILEGING
Facilities rely on the results of external organizations in making recommendations for membership and clinical privileges, which is a form of external peer review. Although it is easy to review performance logs, external peer review also examines the quality of the practitioner’s performance and assists with the required ongoing professional practice evaluations and focused professional practice evaluations (FPPE).
CONFLICT OF INTEREST
Conflict of interest can involve a colleague or partner in the same practice group, social relationships between practitioners, competitors, referral relationships, or financial relationships. In addition, conflicts of interest can arise when the reviewer has had prior involvement in the patient’s care or a familial relationship with the patient or practitioner. External peer review helps to eliminate the appearance of bias in all of these situations, mitigating the potential for litigation.
LACK OF CONSENSUS
In some cases, unclear professional standards make it difficult to determine whether a practitioner has met the professional standards of care. There may also be substantial differences of opinion regarding the assessment of the practitioner being reviewed. The board-certified reviewers who work with independent review organizations keep up to date with the latest standards of care, which continually evolve.
LACK OF SPECIALTY KNOWLEDGE
Some facilities may have departments with just one or two specialists. In these cases, external peer review can be used to perform professional evaluation, as well as identify and evaluate issues that may need to be addressed.
External peer review is not just about sending charts and studies for review. It can also involve using an external proctor for procedures if internal resources are not available.
Due to the inherent issues involved in internal peer review, external peer review is an important and necessary part of the peer review process. As in any type of peer review, the purpose of external peer review is to improve the quality of care provided by the individual practitioners and monitor the performance of the privileged practitioners at the facility. Peer review, both external and internal, must be objective and evidenced-based and should provide unbiased decisions. For many reasons, including conflict of interest and the lack of specialty knowledge or consensus, this can be more easily achieved with external peer review than with internal peer review.