Including Studies for External Review

Problem:

“Our medical staff identified several orthopedic surgical cases that warrant external peer review. The preoperative imaging studies were conducted outside the hospital within the physician’s office. Our medical staff is reluctant to require the physician to provide these images, but the peer reviewer feels they are integral to an effective, thorough review. The peer reviewer also feels that some of the office notes are critical to the review process.”

Solution:

While orthopedic surgery is an excellent example of a specialty that demands that pre- and postoperative studies be included for peer review, it is not alone. Clinical decisions in the disciplines of vascular, cardiac, general and other surgical specialties often hinge on such studies. The fact that these studies are conducted outside the walls of the hospital is not a reasonable justification for excluding them from review. Peer reviewers are put at a significant disadvantage without having access to the very same information that the physician under study used for patient assessment and hospital care. By failing to require that the physician provide the imaging studies that served as a basis for surgery, the hospital often puts itself in a position of commissioning an external peer review that is based, in part, on speculation. This, in turn, leads to conclusions that can be difficult to defend.

Can a physician refuse to provide information that is contained within office records? Such would represent a failure on the part of the physician to recognize that peer review knows no walls. Care is a continuum, often beginning and ending in the physician’s office but with hospital care in the middle. Physicians have the ethical obligation to comply with requests for information that is outside the hospital record in support of the peer review process, even if such compliance is not spelled out in the medical staff bylaws. Physicians not inclined to cooperate might be reminded of their obligation. If not already included, the medical staff might consider incorporating a provision into its bylaws that specifically articulates the requirements for all medical staff members to fully comply with the peer review process.

It is important for all involved to remember that peer review knows no walls. Privileges must be constantly contingent upon the hospital’s complete, unobstructed ability to evaluate patient care for which the hospital is largely responsible.