Involve residents in peer review

Residency Program Insider, August 30, 2005

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Dear residency program colleague:

Many hospitals involve residents in the peer review process. However, if your organization decides to follow suit, you should do so cautiously. The peer review process is there to help improve the quality of care of the medical staff. Generally residents are not members of the medical staff, but information about residents and their involvement in patient care should certainly be included in the process.

To incorporate residents more fully in the peer review process, invite them to speak at a peer review committee meeting to explain actions in which they are involved. Although it is important to provide the resident an opportunity to present this information, he or she should not be permitted to participate in peer review deliberation.

However, you may want to consider allowing a small number of residents (perhaps only the chief resident) to be part of the peer review committee. Keep in mind that such a move may create some controversy. Your hospital will benefit from gathering insight from the residents, but some physicians may be less inclined to have a frank discussion about the care given by their peers with a resident present. Therefore, you might consider having the resident leave the committee during discussions that don't concern resident issues.

For hospitals to protect themselves in situations where residents are involved in litigation, information passed between resident administration should be put under the umbrella of the peer review committee. This can be accomplished by stating in your rules and regulations that when the resident director receives information concerning a resident's competence, he is acting as an agent of the peer review committee.

Everything should be done up-front. Describe the process you will use as part of your rules and regulations or your bylaws before an issue occurs rather than on a case-by-case basis.

That's all for this week!

All the best,

Robert Marder, MD
The Greeley Company

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