Patient Safety Investigation Vs. Peer Review

Peer review is defined as the evaluation or assessment of health care delivery, based upon outcome criteria, that is conducted by the peers of the professionals charged with delivering patient care. The purpose of peer review is:

• To provide a protected place for candid and self-reflective conversation among peers
• To reduce morbidity and mortality
• To improve future outcomes

The focus of a peer review activity is generally the care provided by an individual. Information that is protected under peer review is not discoverable and is inadmissible during malpractice proceedings. In the State of Illinois a peer review document is protected only if it is initiated, created, prepared or generated by a peer review committee. A document that is prepared in advance of a request by a peer review committee or prior to its review of an incident will not be protected.

Under the Medical Studies Act, M&M Conferences and Hospital Patient Safety Committees are both considered to be peer review activities. It is a common misconception that case discussion during M and M conference is the same as a patient safety investigation. These are not the same thing.

A Patient Safety Investigation, such as a Root Cause Analysis (RCA) is a critical aspect in the process of improving patient safety. Interdisciplinary teams investigate adverse events and near misses. The goal is to find out what happened, why it happened, and to determine what can be done to prevent it from happening again.

The focus of a patient safety investigation is on improving and redesigning systems and processes — rather than focus on individual performance, which is seldom the sole reason for an adverse event or close call.

Regardless of the format, components of an interprofessional patient safety event investigation include:

• Review by an inter professional team
• Detailed analysis of systems and processes
• Identification of potential systems changes ( often via Fishbone diagram or other tool)
• Implementation of an action plan.
• Follow-up evaluation of the actions