CASE STUDY # 4: Don’t over react over sample: Confirm physician competency and program quality effectively and efficiently

Midwest Rehabilitation Hospital started a new Wound Care Service (WCS) to complement their expanding ambulatory orthopedic surgery initiatives in April of 2015. At the February, 2016 MEC meeting the Chair of Orthopedic Surgery indicated that a 5 member private orthopedic group complained to him about the quality of care their patients had been receiving from the general surgeons staffing the WCS. The orthopedic group requested that all of the 78 patients they had referred to the WCS be reviewed for appropriateness by an objective outside physician reviewer as the WCS surgeons were either employed by the hospital or in a competing group practice. The MEC directed the Orthopedic Chair to work with the CMO in determining an appropriate review.

The CMO met with the orthopedic group and identified that four primary modalities of wound care were involved with their 78 patients. Next she met with the WCS Clinical Director who had been doing Ongoing Review (OPPE) for the new WCS. They designed an external review that analyzed the top four prevalent clinical protocols provided in the WCS to confirm that the protocols employ contemporary standards of wound care approaches, modalities, and techniques. A randomized and stratified sample of thirty-two (32) medical records (12 from the Orthopedic group) was selected for external review by the CMO. Three records were selected for each of the four protocols for the higher volume WCS surgeons and two cases were selected for each of the four protocols for the lower volume WCS surgeon.

Conclusion: The external reviewer’s finding indicated that a generally recognized standard of care was met as documented in each of the records reviewed. The overall patient care was sound and the results were good. There were minor legibility issues with some provider notes; although it does not appear to have affected care delivery.
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It was the reviewer’s opinion that the WCS’s top four protocols and/practice guidelines were based on generally accepted principles of evidence-based wound care management. The overall WCS physician competency and WCS protocols and quality were confirmed for the entire program with the review of 32 patient records which cost far less than just reviewing 78 of one groups cases. Start small and increase the review if concerns are identified by type of case and by physician.