The Legitimacy of professional conduct Analysis of - - PDF document

1

The Legitimacy of Peer Review

Charlotte Jefferies Horty, Springer & Mattern

• Collection and organization of information

pertaining to the competence and professional conduct

• Analysis of practitioner-specific

information by individuals (“peers”) from the same discipline with essentially

What is peer review?

the same discipline with essentially equivalent qualifications

• Recommendations for actions to protect

patients and for practitioner improvement

• Challenges by affected practitioners to

proposed and actual actions implemented by peers

• Credentialing and Privileging
• Quality Assurance, Quality

Assessment and Performance Improvement

What does peer review include?

p

• FPPE and OPPE
• Collegial Intervention
• Corrective and Disciplinary Action
• Fair Hearing and Appeals

Why Peer Review? y

It’s the Law!!!

• Medicare Conditions of

Participation

• Hospital licensing statutes

Hospital licensing statutes

• Joint Commission and AOA

2

• DNV (Det Norske Veritas)

(NIAHO: National Integrated (NIAHO: National Integrated Accreditation for Healthcare Organizations or “DNVHC”)

It improves patient care and t ti t f t ! promotes patient safety!

Avoid hospital liability for negligent credentialing.

If the heart of a profession is self-regulation, then the medical staff cannot escape medical staff cannot escape the challenge to make peer review work.

• Retrospective
• Rotating, untrained “volunteers”

Why doesn’t traditional peer review work well?

• Perception – punitive
• Fear of “discovery”
• Fear of challenge
• Discomfort with critiquing a

colleague – respect for autonomy

• Poor documentation

Why doesn’t traditional peer review work well?

• Poor documentation
• Consumes time
• “There but for the grace of

God…”

3

What do we want from the peer review process?

• Fair and objective
• Confidential
• Educational
• Educational
• Good memory
• Timely and efficient

Don’t forget to document! Don t forget to document!

Follow up with good and bad news and bad news.

Peer Review Process

F P Focused Professional

FPPE

P E Practice Evaluation

(a.k.a. Provisional Appointment)

4

Those who are new “FPPE”

• Assess privilege specific competence.

Those who are new “FPPE”

• Appropriateness of treatment
• Use of consults
• Adequacy of documentation
• Chart review

Those who are new “FPPE”

• Monitoring
• Proctoring
• External peer review

O

OPPE

Ongoing O P P E Ongoing Professional Practice Evaluation

• OPPE is required for

all practitioners who have been granted clinical privileges, i l di AHP

OPPE

including AHPs

• Routine evaluation to

confirm appropriate practice

• Identify and address

OPPE

• Identify and address

issues early

5 OPPE

• Department selects criteria for OPPE.
• Criteria will vary by department.

Criteria may include: Operative outcomes

OPPE

– Operative outcomes – Blood usage – LOS – Morbidity and mortality – Use of consultants – Medical records completion

OPPE

Once a year is not enough.

OPPE FAQ – 8/13/08

“The fact that a practitioner p doesn’t fall out on pre-defined screening criteria is not sufficient to meet the requirement.”

OPPE

• Review by Department Chair.
• Share with the physician.
• Consider at reappointment.

FPPE

F P Focused Professional Focused Professional P P E Professional Practice Evaluation Professional Practice Evaluation

6

• Referrals from hospital staff and

Medical Staff members/reported concerns

• Patient complaints
• Protocol/guideline not followed

WHEN CONCERNS ARE RAISED FPPE

• Protocol/guideline not followed
• Noncompliance with Rules/Regs/

Medical Staff Policies

• Litigation risks
• Medical necessity
• Sentinel events
• Specialty Specific Indicators
• OPPE Outliers
• Chart review

FPPE

• Monitoring
• Simulation
• Proctoring
• External peer review
• Discussion with others involved in the care
• f each patient

Goals:

• Work with physician to

resolve concerns.

• Improve patient care.

Collegial Intervention: The First Step in the Performance Improvement Process

Know your objectives and plan f th i t ti for the intervention.

Performance Improvement Plans

• Additional education/CME
• Prospective monitoring/review
• Second opinions/consultations
• Concurrent proctoring
• Formal evaluation/assessment
• Additional training

7

Don’t Sacrifice

Tip Tip

Don t Sacrifice Patient Safety for Non-Reportability

Progressive Steps Continuum

Educational Collegial Disciplinary letter

Performance Improvement Plans

g conversation p y action

Not reportable to NPDB

In the rare case when collegial intervention is unsuccessful… Investigation