Synergy - September/October 2012 - 19

industry feature

clinicians meet membership and privileging criteria. One of the key parameters of doing EPR right the first time is to find an external reviewer who has similar education, training, experience and practice/facility experience as the physician being reviewed. As such, she requested the EPR provider to contract with a board-certified general surgeon who had current demonstrated competence with at least five years of experience in doing amputations in a community hospital with inpatient rehabilitation service. The EPR provider identified and verified the credentials of the physician who met these criteria. The MSP reviewed the CV of the proposed external physician reviewer with the attending physician being reviewed to ensure that there was no known conflict of interest. The MSP also was helpful in identifying that the patient questioned the rehabilitation and wound care provided. A rehabilitation nurse experienced in treating similar patient conditions (from the same hospital where the physician reviewer practiced) was contracted to review and comment on the care documented in the acute care and rehabilitation service medical records.

Good project management looks at the due/end date ... and works back from there ...
management and patient concerns that 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). • Should the physician and nursing staff have been more aggressive in “persuading” the patient to have the surgery based on the patient’s condition as documented in the medical record? • Did the patient leave the hospital with a pressure ulcer on the other foot? Was the skin care provided the patient appropriate based on the documentation of the patient’s condition? • In your opinion, would the patient have required as extensive surgery if it were performed sooner during the first admission?”

Ask the Right Questions
The MSP coordinated the specific questions with the CMO and director of quality/risk management that needed to be objectively answered by the reviewer. She followed an EPR best practice by giving specific questions and a clear case description without sharing the PRC’s findings or opinions. “Please document your overall impressions that physician and nursing care and documentation was acceptable, not acceptable or questionable. Provide a narrative description supporting your findings and conclusions pertaining to: • Was the documentation appropriate to capture the patient’s wishes to initially (during the first admission) delay the care and proceed with antibiotic therapy?

Reasonable Cost
The MSP negotiated a set price and timetable for the entire patient acute and inpatient rehabilitation case. This allowed two inpatient admission records and one inpatient rehabilitation record to be reviewed for almost half the cost of reviewing three medical records. The economy of scale of having the physician and nurse from the same facility with the same records simultaneously being reviewed and communicated in the same conference call saved significant time and money.

Begin with the End in Mind
The MSP asked: “After we confirm that care was or was not appropriate, then what?” What will we do with the external review report? The MSP made it clear to the external reviewer to address the risk

This chart that follows indicates the most frequent reasons EPR is requested. The MSP recognized the highlighted criteria, which prompted her recommendation for EPR to the CEO:
ExpErtisE

Coordination and Project Management
Good project management looks at the due/ end date — in this case the PRC next formal meeting date — and works back from there to get the job done. The MSP managed the project to meet that date as follows: • She managed the EPR proposal well: price; due date; qualifications of the physician and nurse; confidentiality and indemnification agreements; records to be reviewed and the methodology; initial conference call date (one week in advance of the PRC); and CEO approval. • The MSP paid attention to the legal details without making a big deal about them. For example, she knew it was important to phrase the request for EPR
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(No other, New Technology, Time) • No members of the PRC/medical staff were able to objectively review the case either due to conflict of interest or concern over appropriate and adequate review, or adequate similar training and expertise. • There was new technology involved, which required assistance from outside experts. • Members of the medical staff did not feel they had adequate time to spend on an in-depth, fair review of the case.
Confirmation of intErnal findings

(OPPE, FPPE, Sentinel Events, Pt/Physician Satisfaction)
objECtivity

(Conflict of Interest, Validate Internal Peer Review)
litigation & liability

(Defense Counsel, Complaints, Due Process)

September /Oct Ober 2012 SYNERGY

Synergy - September/October 2012

Table of Contents for the Digital Edition of Synergy - September/October 2012