The Peer Review Process

The Peer Review Process

The Process

Exter­nal peer review is an impor­tant tool for hos­pi­tals, medical staffs and legal coun­sel when they are con­fronted with con­cerns about qual­ity and/or other seri­ous prob­lems, such as poten­tial lim­i­ta­tion or revo­ca­tion of priv­i­leges. The eval­u­a­tion of the qual­ity of patient care by promi­nent experts is a respon­si­bil­ity the Foundation has under­taken for thou­sands of hos­pi­tals since 1987.

The type and extent of our review and result­ing rec­om­men­da­tions will depend upon the rea­sons that stim­u­lated it and the guid­ance requested. We insure fair eval­u­a­tions and offer sup­port for imple­ment­ing results be it through reed­u­ca­tion, re-credentialing, sys­tem reor­ga­ni­za­tion, medi­a­tion or arbi­tra­tion. When­ever pos­si­ble, the Foundation attempts to work toward edu­ca­tional rather than puni­tive out­comes. The inde­pen­dent eval­u­a­tion by nation­ally rec­og­nized clin­i­cians within the same spe­cialty being eval­u­ated gen­er­ates pos­i­tive pro­fes­sional and behav­ioral change. When needed, on-site instruc­tion, con­sult­ing, and infor­ma­tion shar­ing with sug­ges­tions to improve skills, can be sched­uled fol­low­ing reviews.

Our thought­ful assess­ments come quickly in a user-friendly format…

Reports and Recommendations

Fol­low­ing physi­cian, depart­ment peer review or hospital-wide assess­ment, a report will be sub­mit­ted to the health care facil­ity. It will con­tain a cri­tique of each case record reviewed that is directly respon­sive to the ques­tions raised by the hos­pi­tal. The prin­ci­pal find­ings and appro­pri­ate prac­ti­cal rec­om­men­da­tions for hos­pi­tal action are then sum­ma­rized. If two physi­cians have simul­ta­ne­ously and inde­pen­dently reviewed the same records, the Foundation will send indi­vid­ual or com­bined records, depend­ing upon the pur­pose of the review. We rec­om­mended that the hospital’s legal coun­sel be made aware of the writ­ten recommendations.

The length of time between sub­mis­sion of data by the hos­pi­tal to the receipt of the final writ­ten report varies from a few weeks to approx­i­mately two months or more depend­ing on the com­plex­ity of the review. The Foundation will make every effort to respond to emer­gency sit­u­a­tions even more expeditiously.

After a spe­cialty depart­ment review, the team of experts will develop a ser­vice plan spe­cific to the needs of the depart­ment. This plan will out­line the fac­tors iden­ti­fied that are con­tribut­ing to adverse out­come data or qual­ity of care sta­tis­tics. Rec­om­men­da­tions will out­line solu­tions and offer alter­na­tives for pos­i­tive improve­ment. In addi­tion to rec­om­men­da­tions for pos­i­tive change and solu­tions to inter­nal con­flicts, the review report includes a reme­dial pro­gram devel­oped by the expert review­ers. Sev­eral options may be listed, includ­ing edu­ca­tional pro­grams that may be obtained through var­i­ous spe­cialty soci­eties and our Divi­sion, the Foundation for Advanced Medical Education

Peer review is an edu­ca­tional opportunity…

Both physi­cians and hos­pi­tals appre­ci­ate the post-peer review pre­cep­tor pro­grams admin­is­tered through our divi­sion, The Foundation for Advanced Medical Education. One pro­gram for exam­ple, begins with a promi­nent pre­cep­tor who, in con­junc­tion with didac­tic and lab­o­ra­tory sim­u­la­tor expe­ri­ence, demon­strates new or unfa­mil­iar pro­ce­dures to the pre­ceptee at a uni­ver­sity or other teach­ing hos­pi­tal. This may be fol­lowed by the pre­cep­tor demon­strat­ing sur­gi­cal tech­niques for a defined period of time, and then trav­el­ing to observe on-site in the pre­ceptee’ s own hos­pi­tal. Our new tele­men­tor­ing or remote pres­ence pro­grams may be of assistance.