Medical Peer Review - Overview

Overview

The objective of a medical peer review committee is to investigate the medical care rendered in order to determine whether accepted standards of care have been met. The professional or personal conduct of a physician or other healthcare professional may also be investigated. If a medical peer review committee finds that a physician has departed from accepted standards, it may recommend limiting or terminating the physician's privileges at an institution. Remedial measures including education may also be recommended.

In Nursing, as in other professions, peer review applies professional control to practice, and is used by professionals to hold themselves accountable for their services to the public and the organization. Peer review plays a role in affecting the quality of outcomes, fostering practice development, and maintaining professional autonomy. The American Nurses Association guidelines on peer review define peer review as the process by which practitioners of the same rank, profession, or setting critically appraise each other’s work performance against established standards. Professionals, who are best acquainted with the requirements and demands of the role, are the givers and receivers of the feedback review.

The medical peer review system is a quasi-judicial one, similar in some ways to the grand jury / petit jury system. First, a plaintiff asks for an investigation. Discretionary appointments of staff members are made by the medical Chief of Staff to create an ad hoc committee, which then conducts an investigation in the manner it feels is appropriate. There is no standard for due process, impartiality, or information sources; the review may consult the literature or an outside expert.

An indicted (and sanctioned) physician may have the right to request a hearing, with counsel allowed. A second panel of physicians is chosen as the 'petit jury', and a hearing officer is chosen. The accused physician has the option to demonstrate conflicts of interest and attempt to disqualify jurors based on reasonable suspicions of bias or conflicts of interest in a process akin to voir dire.

The Patient Safety and Quality Improvement Act of 2005 (Public Law 109-41) created Patient Safety Organizations, whose participants are immune from prosecution in civil, criminal, and administrative hearings, in order to act in parallel with peer review boards, using root cause analysis and evaluation of "near misses" in systems failure analysis.