How we’re redefining clinical peer review

Sharon Kimball, RN
Clinical project manager, Quality Management and Medical Staff Services

May 21, 2014

To most physicians the purpose of a clinical peer review is clear – to ensure that patients get the best care and that providers do their best work. Yet to those who have never been through a peer review, the process may be a mystery. How is it triggered? Who’s involved? What happens after the review? Is the process fair?

In April, medical staff leaders representing medical executive committees, credentials committees and peer review panels from all eight Oregon hospitals gathered for a two-day retreat on peer review. Part of the discussion involved standardizing language, charters, forms and letter templates so that the process is uniform across the region.

The rest of the retreat focused on best practices for peer review – chief among them a shift from a largely disciplinary process to one that focuses on learning. The goal is continuous improvement, not only for the provider but for each hospital’s quality and safety efforts.

This work builds on groundwork already established in Providence’s professional staff peer review policy, which details our peer-review process. For the uninitiated, peer reviews generally follow three steps: 

Trigger: Cases are identified through unusual occurrence reports, patient concerns, specialty-specific indicators, risk-management issues, noncompliance with clinical protocols or guidelines, and other causes.

Who reviews: Hospital support staff opens a case and shares the concern with the provider’s department chair. In some cases, the department chair will forward the case to a multidisciplinary peer review council. The involved practitioner is always given the opportunity to reply. Completed and confidential case reviews are stored in the practitioner’s quality file.

What measures are taken: If the case requires corrective action, the practitioner may receive an informational letter, a collegial conversation or be placed on a performance improvement plan.

Going forward, improvement interventions will play an even greater role in peer review. These include behavioral coaching, professional mentoring or clinical education. Focused and ongoing evaluations will involve analyses of clinical practice patterns using evidence-based and comparative data when available. (A system-wide effort is underway to develop tools in Epic for collecting this data.)

When done properly, peer review can improve the quality and safety of patient care, enhance overall clinical performance and augment physician education. Effective peer review starts with an objective review process and emphasizes continuous improvement through education rather than punishment.

We’ll share more details on our changing peer-review process in future issues of Pulse.