4 Things You Need to Know about Medical Peer Reviews
#1. What Are Medical Peer Reviews?
Medical peer reviews are performance assessments. Through this process, peers evaluate other physicians’ clinical performances.
Teams of multiple physicians are assembled, often by administrative committees and ethics committees, to review the patient charts and activities of a particular physician.
The conduct in question may be the result of a single event or a series of events. Depending on the circumstances, the peer review committee may review everything from patient charts to medical notes to billing procedures.
The purpose of the medical peer review is to improve patient safety and the quality of care.
And since physicians know best how to conduct themselves and provide care, it is a group of peers that hold and handle these reviews.
#2 Are All Physicians Subject to Medical Peer Reviews?
Some hospitals may go their entire careers without ever being subject to a medical peer review, particularly those in private practice.
Peer reviews are common practice; however, in hospitals, large healthcare groups, and surgical centers.
Depending on your employer, both physicians and nurses may be subject to peer reviews.
Sometimes, peer reviews begin simply because a physician requests more or new privileges. But in other cases, the trigger is a complaint from other members of your staff concerned about your performance or standard of care.
It doesn’t matter what medical association or medical society you belong to or what medical specialty you practice.
If you work for a large healthcare provider, you should always be prepared for a hospital peer review.
But there is some good news:
A physician under peer review will know before the start of the process or investigation. Even if you face a medical peer review due to a complaint or a potential violation of conduct, your employer will inform you.
#3 How Does the Peer Review Process Work?
There are two main subjects in the peer-review process. The reviewee (the physician under scrutiny) and the reviewer (the team put in place to conduct the investigation).
#4 Who Performs Peer Reviews?
The reviewer can be one individual physician or a committee of doctors, nurses, and other medical staff. In peer reviews for privileging, the credentials committee may be the reviewer.
In other situations, the ethics committee of your hospital board may be the one to conduct the review.
There are also instances where an external peer review committee may be called in to oversee or lead the process.
Regardless of who the reviewer is, the process always follows these steps:
Step 1: The Trigger Event
Something has to happen for you to fall under medical peer review. In many cases, it means that another physician or staff member has reason to suspect misconduct.
Step 2: Initial Review
The committee of your peers will conduct an initial review. During this phase, the reviewer will gather and review the documents in question.
Step 3: Presentation of the Findings
Once the committee has come to a decision, they give the physician a chance to review those findings. As a physician under peer review, you will know what documents are under investigation and when they reach a conclusion.
Step 4: Physician Responds With Feedback
Depending on what the reviewer finds, you may need to provide detailed explanations or evidence to support your actions. Regardless of the findings, you will get an opportunity to respond with feedback.
Step 5: Assignation of Severity and Intervention Score
Once you’ve responded to the findings in your review, the reviewer will assign it a score based on the level of severity.
The best score you can receive is “no error,” meaning that the review team found you did nothing wrong.
The worst score you can receive is “catastrophic error,” which is usually only the case if your conduct resulted in a patient’s death.
Between, there’s a variety of score levels. Some of which are minor and some that may be regarded as moderate or severe.
Depending on the score assigned to your peer review, the hospital board or ethics committee may ask for further monitoring. In extreme cases, you could face disciplinary action.
Why Are Medical Peer Reviews So Important?
Medical peer reviews are important for both physicians and hospitals, but for very different reasons.
Whether you find yourself a physician under review or as a reviewer, it’s essential to know what the process is and what implications it could have for yourself, the hospital, or the medical group.