Good article on physician peer review from 2007 (Questions: Can conflicts of interest ever be effectively controlled? Should all physician peer review be external peer review?)

http://www.psqh.com/janfeb07/peer.html

January / February 2007

Peer Review

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Best Practices for Enhancing Quality

By Skip Freedman, MD

"Establish policies for referring cases for external review. Given the responsibility to maintain high quality standards and impartiality, it's important that hospitals and other healthcare providers have an objective and expert resource for evaluating quality of care concerns or controversies. Many hospitals are moving toward including an independent review organization (IRO) as an unbiased external review authority and as a best practice whenever there is:

• Doubt about the case analysis.
  
• A perceived economic or other conflict of interest.
  
• A need for a second opinion or outside perspective.
  
• A pool of specialists that is small or when no appropriate "peer" is available.
  
• A physician under review making an appeal.
  
• No one on the staff qualified to review a particular specialty.
  
• A need for objectivity about disciplinary action
  
• New technology being used that the staff is inexperienced with it.
  
• A high likelihood of litigation
  
• Either a general or specific concern about clinical outcome.

Today many risk and quality managers in hospitals understand these issues; an increasing number of them are turning to external reviews to ensure their peer reviews remain unbiased."