Ask the expert: When is it appropriate to use external peer review?

Hospitals should have a policy that clearly describes the circumstances under which it would seek the assistance of an external peer review organization. Prior to utilizing an external peer review organization, the hospital should do its due diligence in researching the different organizations’ reputations as well as reviewing the competency, training, and experience of the reviewer. Some examples of when hospitals should use external reviews include (but are not limited to) the following:

• Lack of internal expertise: Many hospitals, particularly rural facilities, occasionally are forced to rely on external peer review organizations because current medical staff members do not have expertise in the specialty under review.
• Conflict of interest: You should also use external peer review organizations when the only practitioners on the medical staff with expertise to review the specialty are associates, partners, or direct competitors of the practitioner under review. Organizations need to ensure that they do not give any room for accusations of bias. 
• New technology: When purchasing new equipment or researching new techniques, your organization may not have current medical staff members with the appropriate training or experience. Organizations can utilize external resources to provide the training or proctoring needed to implement the new techniques.
• Miscellaneous issues: Most hospitals adopt external peer review policies that allow the medical executive committee and governing board to use external peer review whenever deemed appropriate (e.g., when the medical staff needs an expert witness for a fair hearing, to evaluate a practitioner’s credentials file, or to develop benchmarks for quality monitoring).

This week’s question and answer are from The Essential Guide to Medical Staff Reappointment: Tools to Create and Maintain an Ongoing, Criteria-Based Process by Anne Roberts, CPMSM, CPCS.