QUESTION:
When should we request input from physicians when one of their cases is identified for review through our peer review process?
OUR ANSWER FROM HORTYSPRINGER ATTORNEY PHIL ZARONE:
Some physician leaders want to obtain input as soon as a case is identified for review, before the case is sent to the initial committee in the review process (referred to as the Clinical Specialty Review Committee (“CSRC”) in our model). Their rationale is that obtaining input right away (before the case is sent to the CSRC) will expedite the CSRC’s review of the case. The CSRC won’t have to delay reviewing the case until its next meeting while it waits for the physician’s input. Also, obtaining input right away might emphasize to Medical Staff members that the process is transparent and their input will be considered.
The problem with obtaining a physician’s input immediately is that the CSRC might have decided that the case raises no concerns even without the physician’s input. In that situation, the physician will have spent time preparing comments that weren’t needed. This wastes the physician’s time and probably creates unnecessary anxiety.
To get the best of both worlds, the peer review process might include a triage step. The Chair of the CSRC could review cases and identify those that are more likely to require review by the CSRC. For those cases, input could be obtained prior to the CSRC meeting. For other cases, input would only be obtained if the full CSRC believes it’s necessary.
Another option would be to get input from the physician right away if a case is identified due to a reported concern, referral from a sentinel event, referral from risk management, or some other source that makes it more likely that the CSRC will want to review the case. But input might not be obtained right away for cases identified by a pre-determined trigger (because sometimes triggers can be more sensitive and identify cases that don’t raise a concern).
If you have a quick question about this, e-mail Phil Zarone at pzarone@hortyspringer.com. Or, join us at the Peer Review Clinic in Phoenix, AZ from November 16-18, 2023.