On-site vs. Off-site Peer Review

Problem:

“Our medical staff insists that the external peer reviewer conduct reviews on site. What are the advantages and disadvantages of this approach?”

Solution:

A common presumption is that on-site reviews are superior. While this might be the case in certain situations, there are downsides. When an on-site review is being contemplated, the advantages should be weighed against the disadvantages. Generally, the following warrant consideration:

Advantages of On-Site Review:

• Staff and physician(s) are readily available for interviews.
• Additional documentation can be readily obtained, including charts, reports, actual film studies and policies and procedures.
• Direct observation of clinical practice is possible.
• Discussion with leadership can be arranged.
• Insight into facility, personalities and culture may be gained.

Advantages to Off-Site Review:

• Objectivity can be maintained without bias from new relationships.
• Peer review of the medical record can be more thorough without extreme time limitations.
• Resource materials can be more easily accessed and thoroughly considered.
• Costs are typically lower without travel-related expenses.
• Greater sensitivity to individual and meeting schedules can be afforded.

Occasionally, some of our clients have insisted that some level of review occur on site. There are times when this makes great sense, such as when direct observation of surgical technique is critical to the review. However, even in such situations, review of records off site, in advance of a site visit, is usually still the best approach. All of the advantages of off-site review of the records, particularly the preservation of objectivity and thoroughness with which each case can be considered, can be maintained while still fulfilling the objectives of a site visit.

In the vast majority of cases, we have been able to support our clients with excellent peer review results completely with off-site review, although, as noted above, there are times when only on-site review will do. When dialogue has been necessary, phone and video conferences not only achieved the desired objectives, but were far less costly, much easier to schedule and more supportive of greater participation. The key is to always keep the objectives of each peer review in mind and then to construct a process that fulfills those objectives with utmost sensitivity to costs, time and process integrity.