The design and function of a peer review process

According to the Joint Commission memorandum addressing peer review processes, a properly designed peer review process should:

• define those circumstances requiring peer review;

• specify participants in the review process, including a definition of "peer" developed by the medical staff;

• define a method for selecting peer review panels for specific circumstances;

• identify time frames in which peer review activities are to be conducted and the results reported;

• specify circumstances under which external peer review is required;

• provide for participation of the reviewee in the peer review process.

An effectively functioning peer review process should include:

• consistency in all cases meeting the organization’s definition of reviewable circumstances;

• timeliness in which procedures are reasonably adhered to;

• defensible conclusions reached through processes which include, as appropriate, reference to the literature and relevant clinical practice guidelines;

• balanced consideration of minority opinions and views of the review;

• usefulness in practitioner-specific credentialing and privileging decisions and, as appropriate, the organization’s performance improvement activities;

• ongoing monitoring of peer review decisions and actions for effectiveness.