CASE STUDY #2: MSP’s Businesslike and Professional Coordination of the Risk Management & Peer Review Process that satisfied the Patient’s concerns

Carefine Hospital’s internal Peer Review Committee (PRC) reviewed a patient case referred from the risk management department based on a patient complaint. They found the care by the physicians and nursing/therapy staff to be appropriate. The Director of Quality/Risk Management Department was concerned that the CMO and VP of Patient Services communication with the patient was not satisfying the patient’s concerns. The CMO asked the Medical Staff Professional (MSP) to objectively review the case and make suggestions. The MSP reviewed the entire case review up to that point. She identified the real issues were:

1. The need to objectively confirm the internal PRC opinion that the care provided and documentation was, in fact, appropriate. The external peer review (EPR) policy states that there are many instances in which EPR is requested to obtain confirmation that work was performed well -not just for “problem cases”. Carefine leaders fostered a culture of not making PRC members say that care was bad – only that it needs further objective review.
2. Carefine Hospital needed to be able to show the patient that the quality of care provided was appropriate based on the opinion of objective, national experts who have handled many similar cases; and,
3. Questions were being raised by the patient that went beyond physician care requiring nursing rehabilitation care to be objectively reviewed and answered.

The MSP recommended and obtained the approval of the CEO for an external peer review (EPR). The MSP made it clear to the external reviewer to address the risk management and patient concerns which were provided with the medical records. This positioned the CMO to have the information needed to openly communicate the objective findings/opinions with the patient (after discussing with risk management and legal counsel).

Conclusion: The external review report, in fact, confirmed that the care and documentation provided was appropriate and met a generally recognized standard of care. The physician, nurses and therapists involved with the patient’s care were thanked. The specific patient’s questions asked by Carefine were answered by the EPR. Segments of the actual EPR report were shared with the patient. The EPR report positioned the CMO to have a number of productive discussions with the patient and his family to respond to their questions. Additional risk management approaches were also used to enhance the patient’s relationship with Carefine. The patient is continuing to be treated at Carefine’s outpatient rehabilitation facility. The MSP’s careful coordination skills, knowledge and approach made a quality review happen in a timely and cost effective manner.
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The MSP plays a significant role in the Medical Staff Peer Review process. Many facilities are now incorporating the medical staff peer review process into the job description of the medical staff professional. Medical staff leaders trust the medical staff professional when it comes to a fair peer review process. Where once this was solely the responsibility of the quality department, more and more facilities are now incorporating the peer review process into the medical staff resources department.