Peer Review Records: Garbage In, Garbage Out

April 17, 2019 | Posted in Healthcare Consulting

Bear with Trash Metaphorically Improving Medical Staff

It’s not easy to find examples of when putting garbage into a process generates something valuable.  A recycling program that takes what would otherwise be trash and converts it into new products comes to mind.  Or artists who turn junk into unique creations.  But when it comes to physician peer review, it’s garbage in, garbage out.  Much of what goes “in” are records of patient care.  What comes “out” is information from a peer physician used most typically for some form of quality improvement or risk identification.  If the peer charged with the case review responsibility is given incomplete, inaccurate or tainted records, there is strong potential for erroneous conclusions.  Given how serious are the implications of reaching the wrong conclusions, peer review has to be conducted with the utmost discipline.  With respect to the records submitted for review, here are five critical recommendations:

  • Provide complete medical records to the reviewer.  Seldom is any purpose served by guessing or assuming what records or portions of records the reviewer will need.  Submitting partial records creates the risk of not only reaching erroneous conclusions, but also slowing the review process when the reviewer requests missing records.  When in doubt, don’t leave it out!  This includes imaging studies for several specialties.
  • Avoid allowing anyone to come between the reviewer and the medical records.  Letting others examine the information and summarize it for the reviewer may save the reviewer time but creates a failure point that can reduce process integrity.  Let the reviewer determine what the records say; don’t ask the reviewer to rely on the interpretation of others.
  • Don’t forget office records.  Sometimes, the hospital record doesn’t tell the complete story.  Making determinations without considering relevant information that resides in office records can be problematic.  We hear too often that records can’t be obtained from the office because the physician is not an employee, or that it is not known whether the office records are relevant.  But if you are doing peer review with your physicians and not to them, why not ask: “As you know, we are sending MR# 34322 for external review.  Are there any office records you believe might be of value to the reviewer?”
  • Organize the records.  Giving the reviewer a several hundred or thousand-page stack of paper (electronic or actual paper) makes the review process tedious, time consuming, and costly while increasing the chances that key information will be overlooked.  Records are best submitted electronically with tabs or bookmarks inserted so the reviewer can easily find and quickly navigate to key information.
  • Consider the timeframe.  Sometimes submitting the record for a single admission is adequate.  But ask: Is any care provided during previous admissions or visits relevant?  Is any subsequent care shed light on what happened previously?  And do I have the right admission(s)?

Even in expedited review situations, it pays to take the time to ensure all the right records are submitted and that they are well-organized.  Cutting corners or trying to guess what the reviewer will need can not only jeopardize the process, but also lead to incorrect conclusions that threaten the defensibility of leadership decisions.  The best peer review demands disciplined selection and submission of records.