Ask the expert: What circumstances require external peer review?

The peer review committee typically commends external peer review to the medical executive committee (MEC) under the following circumstances:

• Litigation: When dealing with the potential for a lawsuit.
• Ambiguity: When dealing with vague or conflicting recommendations from internal reviewers or medical staff committees, and when conclusions from this review will directly affect a physician's membership or privileges.
• Lack of internal expertise: When no one on the medical staff has adequate expertise in the specialty under review, or when the only physicians with that expertise are determined to have a conflict of interest.
• New technology: When a medical staff member requests permission to use new technology or to perform a procedure new to the hospital and the medical staff do not have the necessary subject matter expertise to evaluate adequately the quality of care involved.
• Miscellaneous issues: When the medical staff need an expert witness for a fair hearing, for evaluation of a credential file, or for assistance in developing a benchmark for quality monitoring. In addition, the MEC or governing board may require external peer review in any circumstances deemed appropriate by either of these bodies.