Focused peer review: the end game of peer review

The aim of this report is to describe the authors' experience with expanding the routine peer-review process to include misdiagnoses from all sources and the use of focused peer review (FPR) in faculty accountability and management.

A department-wide routine peer review was conducted. Each radiologist was assigned 12 cases per month. In addition, clinically reported errors, missed diagnoses discovered outside the routine peer-review process, were identified. Cases were scored from 1 to 5. The department quality office evaluated cases with scores of 3 and 4 from both sources for further processing with FPR, a multistep continuation of the peer-review process using a tracking document. Once initiated, FPR was processed by seeking comments from the division director and the interpreting radiologist. In some cases, FPR was discontinued before completion. Completed FPR documents were submitted to the department chair for administrative action, ranging from no action to termination. All FPR cases are presented at monthly departmental morbidity and mortality conferences.

Routine peer review was done on 1,646 cases from a total of about 300,000 studies by 31 radiologists. Thirty-five cases from the two sources with scores of 3 and 4 were analyzed, 21 from the routine peer review and 14 clinically reported errors. The quality officer initiated 25 FPRs, rejecting 10 because errors were not considered significant. Further scrutiny lead to dropping 7 of the 12 routine and 2 of the 13 cases with clinically reported error. Sixteen FPRs were completed, 5 (31%) from routine peer review and 11 (69%) from clinically reported errors. For these 16 completed FPRs, management decisions were made by the department chair.

Processing of routine peer-review data together with cases of clinically reported error strengthens the peer-review process. Focused peer review can effectively contribute to the surveillance and management of faculty performance for improved patient care.