Have a policy to determine when to use external peer review

Whether it is due to a conflict of interest of a lack of staff with the proper expertise, most organizations will eventually need to use external peer review. It is recommended that all organizations have a policy regarding external peer review. Although instances of when to use external peer review should be treated on a case-by-case basis, having a policy will hopefully help to ensure a fair process.

A policy should, at a minimum, contain the following:

  • Peer review protections clause
  • Composition of the peer review committee, committee duties and responsibilities, and quorum requirements
  • Circumstances/triggers for internal peer review
  • Circumstances/triggers for external peer review
  • Committee referral process (i.e., how cases get referred to and accepted for review by the committee)
  • Committee review and notification process (how review is conducted, what notification goes to the provider under review, what the provider's rights are, when the provider can meet with the committee, etc.)
  • An outline of the process for handling any cases that are deemed to deviate from the standard of care (i.e., possible referral to the medical executive committee for corrective action)
  • How nonclinical process issues that may be identified during the course of the review are addressed and whom they're addressed by (e.g., referred to risk management or other appropriate department for follow-through)
  • How cases are handled when they do not rise to the level of formal committee review

Ultimately, the decision to use an external peer reviewer should be made by the peer review committee. If there is disagreement amongst committee members, the matter should be referred to the medical executive committee for consideration.