Advertisement

Clinical perspective: creating an effective practice peer review process—a primer

Published:November 22, 2016DOI:https://doi.org/10.1016/j.ajog.2016.11.1035
      Peer review serves as an important adjunct to other hospital quality and safety programs. Despite its importance, the available literature contains virtually no guidance regarding the structure and function of effective peer review committees. This Clinical Perspective provides a summary of the purposes, structure, and functioning of effective peer review committees. We also discuss important legal considerations that are a necessary component of such processes. This discussion includes useful templates for case selection and review. Proper committee structure, membership, work flow, and leadership as well as close cooperation with the hospital medical executive committee and legal representatives are essential to any effective peer review process. A thoughtful, fair, systematic, and organized approach to creating a peer review process will lead to confidence in the committee by providers, hospital leadership, and patients. If properly constructed, such committees may also assist in monitoring and enforcing compliance with departmental protocols, thus reducing harm and promoting high-quality practice.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chun J.
        • Bafford A.C.
        History and background of quality measurement.
        Clin Colon Rectal Surg. 2014; 27: 5-9
        • Boothman R.
        Provocative ACM session to examine solutions to the medical liability crisis.
        ACOG Today, American College of Obstetricians and Gynecologists. April 2008;
        • Kadar N.
        Peer review of medical practices: missed opportunity to learn.
        Am J Obstet Gynecol. 2014; 211: 596-601
        • Kadar N.
        Systemic bias in peer review: suggested causes, potential remedies.
        J Laparoendosc Adv Surg Tech A. 2010; 20: 123-128
        • Clark S.L.
        • Xu W.
        • Porter T.F.
        • Love D.
        Institutional influences on the primary cesarean section rate in Utah, 1992 to 1995.
        Am J Obstet Gynecol. 1998; 179: 841-845
        • Mah M.P.
        • Clark S.L.
        • Akhigbe E.
        • et al.
        Reduction of severe hyperbilirubinemia following institution of universal predischarge bilirubin screening in a large private hospital system.
        Pediatrics. 2010; 125: e1143-e1148
        • Clark S.L.
        • Meyers J.A.
        • Frye D.K.
        • Perlin J.A.
        Patient safety in obstetrics: the Hospital Corporation of America experience.
        Am J Obstet Gynecol. 2011; 204: 283-287
        • Clark S.L.
        • Belfort M.A.
        • Meyers J.A.
        • et al.
        Improved outcomes, fewer cesarean deliveries and reduced litigation: results of a new paradigm in patient safety.
        Am J Obstet Gynecol. 2008; 199: 105.e1-105.e7
        • Clark S.L.
        • Belfort M.A.
        • Dildy G.A.
        • et al.
        Reducing litigation through alterations in practice patterns.
        Obstet Gynecol. 2008; 112: 1279-1283
        • Clark S.L.
        • Meyers J.A.
        • Frye D.R.
        • et al.
        Recognition and response to electronic fetal heart rate patterns—impact on newborn outcomes and primary cesarean delivery rate in women undergoing induction of labor.
        Am J Obstet Gynecol. 2015; 212: 494.e1-494.e6
        • Pettker C.M.
        • Thung S.F.
        • Lipkind H.S.
        • et al.
        A comprehensive obstetric patient safety program reduces liability claims and payments Am J.
        Obstet Gynecol. 2014; 211: 319-325
        • Arora K.S.
        • Shields L.E.
        • Grobman W.A.
        • et al.
        Triggers, bundles, protocols, and checklists—what every maternal care provider needs to know.
        Am J Obstet Gynecol. 2016; 214: 444-451
        • Shields L.E.
        • Warner S.
        • Klein C.
        • et al.
        Use of maternal early warning trigger tool reduces maternal morbidity.
        Am J Obstet Gynecol. 2016; 214: 527.e1-527.e6
        • Grunebaum A.
        • Chervenak F.
        • Skupski D.
        Effect of a comprehensive obstetric patient safety program on compensation payments and sentinel events.
        Am J Obstet Gynecol. 2011; 204: 97-105
        • Clark S.L.
        • Christmas J.T.
        • Frye D.R.
        • et al.
        Maternal mortality in the US—predictability and the impact of protocols on fatal post-cesarean pulmonary embolism and hypertension-related intracranial hemorrhage.
        Am J Obstet Gynecol. 2014; 211: 32.e1-32.e9
        • Clark S.L.
        • Meyers J.A.
        • Frye D.K.
        • et al.
        A systematic approach to the identification and classification of near-miss events on labor and delivery in a large, national health care system.
        Am J Obstet Gynecol. 2012; 207: 441-445
        • Tolcher M.C.
        • Torbenson V.E.
        • Weaver A.L.
        • et al.
        Impact of a labor and delivery safety bundle on a modified adverse outcomes index.
        Am J Obstet Gynecol. 2016; 214: 401.e1-401.e9
        • Phelan J.P.
        • Korst L.M.
        Establishing a culture of patient safety in a community hospital.
        J. Healthcare Risk Manag. 2011; 31: 12-18
        • Leape L.
        • Epstein A.M.
        • Hamel M.B.
        A series on patient safety.
        N Engl J Med. 2002; 347: 1272-1274
        • Wachter R.M.
        Patient safety at ten: unmistakable progress, troubling gaps.
        Health Aff. 2010; 29 (Available at:) (Accessed July 4, 2016): 165-173
        • National Academy of Sciences
        To err is human: building a safer heath system.
        Institute of Medicine, National Academy of Sciences, Washington (DC)2000
        • National Academy of Sciences
        Crossing the quality chasm: a new health system for the 21st century.
        Institute of Medicine, National Academy of Sciences, I Washington (DC)2001
        • Blenko M.W.
        • Mankins M.C.
        • Rogers P.
        Decide and deliver: 5 steps to breakthrough performance in your organization.
        Harvard Business Press, 2010
        • Klimek P.
        • Hanel R.
        • Thurner S.
        Parkinson’s law quantified: three investigations on bureaucratic inefficiency.
        Physics and society. 2008; (Available at:) (Accessed November 28, 2016)
        • Freedman S.
        Best practices for enhancing quality.
        Patient Safety and Quality Healthcare. 2007; (Available at:) (Accessed November 28, 2016)
      1. US Department of Health and Human Services. The national practitioner data bank guidebook. Available at: https://www.npdb.hrsa.gov/. Accessed July 4, 2016.

        • Babitstky S.
        • Mangravati J.
        The biggest legal mistakes physicians make: and how to avoid them.
        SEAK Inc, Falmouth (MA)2005
      2. Williams JR, Mechler KK, Akins RB, et al. The rural physician peer review model: a virtual solution. Available at: http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Williams_115.pdf Accessed July 4, 2016.

        • Clark S.L.
        • Frye D.R.
        • Meyers J.A.
        • et al.
        Reduction in elective delivery prior to 39 weeks gestation—comparative effectiveness of 3 approaches to change and the impact on neonatal outcome and stillbirth.
        Am J Obstet Gynecol. 2010; 203: 449.e1-449.e6

      Linked Article