Provide physician reviewers with guidance

The primary question a physician reviewer is trying to answer is whether a physician’s actions and decisions were appropriate independent of the care outcome. One of the main components of reviewing performance is identifying the key issues of the case. The following are some questions for the reviewer to consider that will help with this task:

• Was an important diagnosis not considered?
• Was an important procedure, medical treatment, or test not indicated or appropriate at the time it was performed?
• Was an important procedure, medical treatment, consultation, or diagnostic test not performed that should have been?
• Was there a problem with procedural technique?
• Was there a delay in diagnosis, evaluation, consultation, intervention, or decision making that affected the patient’s clinical condition?
• Was there a problem with communication, coordination of care, or supervision that affected the patient’s clinical condition?