External peer case review peer review committee may 2012
This presentation is the property of its rightful owner.
Sponsored Links
1 / 16

External Peer (Case) Review Peer Review Committee May 2012 PowerPoint PPT Presentation


  • 74 Views
  • Uploaded on
  • Presentation posted in: General

External Peer (Case) Review Peer Review Committee May 2012. Welcome. You are helping colleagues in other Oregon CAHS by providing true peer case review. Many of you have been doing case reviews already and your time is valuable so we will try to respect that today.

Download Presentation

External Peer (Case) Review Peer Review Committee May 2012

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


External peer case review peer review committee may 2012

External Peer (Case) Review

Peer Review Committee

May 2012


Welcome

Welcome

  • You are helping colleagues in other Oregon CAHS by providing true peer case review

  • Many of you have been doing case reviews already and your time is valuable so we will try to respect that today.

  • There may be portions of case reviews about which you are uncertain and we hope to make you feel more comfortable with doing these reviews.


Agenda

Agenda

  • The Need for Case Review.

  • The People & Organizations Involved in the ORHQN Case Reviews.

  • Key Legal & Regulatory Information.

  • How to Approach Reviewing a Record.

  • How to Use the ORHQN Review Tools.


The need for case review

The Need for Case Review

The principle reason for doing the case reviews

To provide our fellow medical staffs with an independent look at the reasonableness of providers‘ documented actions during a patient's hospitalization.

Hopefully the reviewer can identify opportunities for improvement. Example: trauma case

Other reasons include: requirement for participation as a CAH, medical staff credentialing requirements.

The point is that by doing them we all contribute our professional skills towards providing and improving care to patients served by CAHs in Oregon.


Who and what

Who and What

The Providers Involved in the Hospitalization

The Peer Review Body of the Treating CAH

Key Contact Person there to Coordinate Requests

ORH (EJ) to Match Requests with Reviewers

Key Contact at Reviewing Institution Receives and Distributes Request

Reviewer (you) Completes the Review and Returns to your Key Contact

Reverse the Flow Back to the Requesting Hospital

ORHQN Provides the Oversight, Training, Finances and Evaluation


Review request flow

Review Request Flow

Hospital

Sending

Hospital contact completes new row on Documents Sent Tracking form

Hospital contact fills out request

Hospital contacts ORHQN Coordinator for invoice and case number

Hospital contact copies medical record, tabs sections & attaches form

Hospital contact double wraps documents, stamps “Privileged and Confidential” and sends to ORHQN

Confidential


Received review request flow

Received Review Request Flow

Receiving

Hospital

Hospital contact completes new row on Documents Received Tracking form and forwards records to physician for review

Physician completes External Case Review Report and returns records and report to Hospital contact

(30 day time frame)

Hospital contact completes remaining fields on form and double wraps documents, stamps “Privileged and Confidential” and sends to ORHQN

Confidential


Key legal regulatory information

KeyLegal & Regulatory Information

Protected by ORS 41.675as a Peer Review Body

Has all the confidentiality requirementsof a medical record under EMTALA

There is a confidentiality agreement for all reviewersand reviewing institutions to sign prior to doing a review.


How to approach reviewing a record

How to ApproachReviewing a Record

Use the submitted record to review the providers' actions based on the information they had available to them at the time of that decision or action.

Consider:

A. Completeness was there sufficient information upon which to act.

B. Commissions: what was done

C. Omissions: what wasn't done that could reasonably have been done at that time.

D. Reasonableness: was it clinically appropriate even though it may not be what the reviewer would have chosen to do.

E. Consistencies: are the observations and actions of the providers seem consistent with that of other clinical staff.

F. Timeliness.


Key point as a reviewer

Key Point as a Reviewer

Identify but don’t speculate on the causes for a problem or missed opportunity.

You are essential to the identification but it is the local Peer Review Committee that is in the best position to determine the causes.


Documents you use see

Documents You Use & See

Review Request

Routine Review

Review for Cause


Questions

Questions


  • Login