Question:  We sent a case out for external review and what we got back is not exactly what we were hoping for.  The report provides valuable information about what went wrong and what could have been improved.  Unfortunately, the “all-in-one” report critiques several physicians and nurses – identifying them by name – and addresses areas where the hospital’s own processes contributed to the poor outcome.  I’m afraid that if we show this report to the doctor about whom we are primarily concerned, he will simply focus on the areas that critique others.  What can we do?

Answer:  The scenario that you report is not all that uncommon.  Without explicit guidance, many providers of clinical reviews provide reports in the manner that does not best serve the needs of those on the receiving end, who must fit them into the peer review and performance improvement processes at their hospital.  It is not necessarily that external reviewers are trying to be complicated.  It’s just that to them, it seems logical when asked to review a case to simply identify all of the areas where concerns are noted and/or where there is room for improvement.  For this reason, it is important that peer reviewers who seek external reviews always have written agreements with the reviewer.  That agreement should clearly outline expectations for the review, the report, and any follow-up that may be necessary.  Be sure to address at least the following:

• Qualifications of the reviewer(s)
• Nature of the review (number of cases, extent of review)
• Format of final report (clinical conclusions only; information separated based on identity of individual about whom concerns are raised)
• Participation in medical staff hearings and litigation which result
• Response to any external review obtained by physician
• Response to any real by physician
• Timeliness (of review and any follow-up services required)
• Confidentiality

For more details on obtaining external reviews – and incorporating them into an efficient, effective, and thoughtfully-designed performance improvement process, join us October 4-6 for The Peer Review Clinic, being offered at the beautiful and serene Fairmont Princess in Scottsdale, Arizona.