Implementing retrospective proctoring

When implementing retrospective proctoring, it is important to standardize the approach. One good practice is to have medical records prescreened by a nonphysician reviewer (typically a nurse in the quality department). This pre-review is used to highlight major issues and concerns in the chart and to tab significant outcomes and can be used to abstract a basic outline of the clinical events. This makes retrospective proctoring more efficient and less burdensome on the time of a physician reviewer. It also helps the reviewer to quickly home in on the salient concerns that might be otherwise obscured in a thick chart.

Retrospective proctoring should be carried out consistently with common case review methodology. This methodology should be formally adopted by the medical staff and utilized by all proctors after a proper orientation. Many medical staffs also employ a scoring approach to help identify the seriousness of concerns and better track trends. Other medical staffs avoid scoring because they believe a narrative description of findings is most useful. The leaders of these latter medical staffs worry that assigning a case a score is less acceptable to doctors who dislike being graded. They note that a score has the potential to become a weapon used against physicians when plaintiff attorneys become aware of its existence, and they note that a score is too “black and white” to account for the complexities and nuances of medical care.

Source: Proctoring, FPPE, and Practitioner Competency Assessment: A Clinical Leader’s Guide