Hospital peer review

Hospital peer review is the evaluation of a physician's performance or an investigation into an undesired outcome in a medical procedure conducted within a hospital or medical group. Usually peer review involves a panel of reviewers in the same geographic area and in the same specialty.

Peer review is part of the Health Care Quality Improvement Act passed by Congress in 1986. The law establishes a framework for investigating a physician's performance to assure that he or she is meeting accepted standards of care. Hospital based peer review involves review of a physician's care by their 'peers'; physicians who practice in the same or a related specialty to the physician being evaluated. The review should not be by a physician involved in the case, although the physician being reviewed can explain or justify their care. State and Federal laws protecting hospital peer review from discovery by malpractice plaintiffs and lawyers permit examination of medical problems without fear that such investigations will be used against the physician or hospital.

Several problems involving peer review can have a chilling effect on doctors without improving the quality of care for patients. Doctors have been subjected to peer review simply because they are outsiders in their organizations or when they challenged their institutions by recommending improvements for patient care. Peer review panels can be competitors of the doctor being reviewed. In smaller institutions it can be difficult to find a doctor with the same subspeciality to perform the peer review. There are various ways to improve peer review in these situations, including interhospital peer review arrangements, combining similar departments (e.g. Family Medicine and Internal Medicine physicians into a Primary Care peer review panel) or turning to third parties, such as independent review organizations, to conduct peer reviews. The burgeoning patient safety movement is affecting traditional peer review to improve systems of care, rather than only focusing on 'bad apple' doctors. Research has shown that the most frequent cause of a poor medical outcome is not the failure of an individual physician to perform to the standard of care, but rather the failure of the systems of care in the hospital 1. An effective peer review program will identify both individual physician problems and systems issues at the hospital that can lead to improved care for future patients.

In response the the Health Care Quality Improvement Act of 1987, ( HCQIA) (P.L. 99-660 )Past Presidents and Executives of national medical associations and health care organizations formed a non-profit corporation to provide independent assessment of the quality of medical care by eminent physicians and surgeons. The American Medical Foundation for Peer Review and Education ( AMF ) is now 20 years old and has provided good faith physician and medical staff peer review,specialty department assessment and entire hospital quality of care evaluation for over 2000 of the nations community and academic hospitals. www.medicalfoundation.org Their division the Foundation for Advanced '''Medical Education (FAME) developed a template with a 2 million dollar grant and six specialty societies to help physicians learn how to use new procedures and devices in a more comprehensive way.