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.
External Peer (Case) Review
Peer Review Committee
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.
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
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
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
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.
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.
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.
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.
Review for Cause