Case Review Reports

 

Hospital peer review is not a “one size fits all” proposition. The type of peer review report needed to assess a case or practitioner can vary depending on the severity of the case, the political climate, government or agency oversight, and the available resources of the hospital.

National Peer Review Corporation continues to offer hospitals maximum flexibility to accommodate these varying circumstances with the In-Depth Case Review Report and the Summary Peer Review Report. 

In-Depth Report 

 When circumstances require comprehensive, detailed findings and case summaries, the NPRC In-Depth Report is considered the “gold standard” for external peer review reports. Proven to be effective, the NPRC In-Depth Report includes the following specific components:

  • An Executive Summary that concisely encapsulates the findings of the NPRC peer reviewer.
  • An abstract of the medical records for each case.
  • Answers to pertinent clinical questions within the expertise of the peer reviewer, while eliminating extraneous issues.
  • Clear and concise findings and conclusions regarding the medical management of the cases, including the degree of concern (e.g., was it a deviation from the accepted standard of care or an issue requiring additional review or education), and the impact, or potential impact, on patient care.
  • The curriculum vitae of the peer reviewer.

In reviewing a NPRC In-Depth Report during litigation, a court noted:

[The NPRC peer reviewer] identified a number of instances in which [the physician] exhibited a lack of medical knowledge and deviated from the standard of care…[and] also identified instances in which the physician intervened when the patient’s condition did not warrant intervention and in which she failed to consider relevant treatment alternatives. Further [the NPRC peer reviewer] questioned her drug choice and dosage in several situations.

Standing alone, the NPRC In-Depth Report has proven to be the format that ensures that the necessary information is readily available, particularly in contentious circumstances such as hearings and litigation.

Summary Report

The NPRC Summary Report provides the same comprehensive evaluation by NPRC’s expert physician reviewers, but in a more concise format. Customizable to the needs of the hospital, the hospital is able to control the level of detail and, therefore, control the cost of the review without sacrificing the high quality. 

At its most basic, the NPRC Summary Peer Review Report provides the following findings:

  • Does the case satisfy recognized standards of care?
  • If the case appears to fail to satisfy recognized standards of care, what is the basis for this determination?
  • Does the medical record documentation comply with recognized documentation requirements?

The hospital can determine, upon review of these findings or as part of the same report, if a more in-depth review of any cases that appear to fail to satisfy recognized standards of care should be obtained. Alternatively, the NPRC Summary Report may include an Executive Summary of the NPRC physician reviewer’s findings that provides an overview of the issues and concerns identified in the reviewed cases.

Simple and more economical, many of our hospital clients have found that the NPRC Summary Peer Review Report provides sufficient information in certain situations, particularly for routine OPPEs and FPPE reviews where performance issues are not anticipated, while providing the flexibility needed to accommodate ongoing peer review.