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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Clinical peer review | 1/5 | https://en.wikipedia.org/wiki/Clinical_peer_review | reference | science, encyclopedia | 2026-05-05T09:52:52.389008+00:00 | kb-cron |
Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. A discipline-specific process may be referenced accordingly (e.g., physician peer review, nursing peer review). Today, clinical peer review is most commonly done in hospitals, but may also occur in other practice settings including surgical centers and large group practices. The primary purpose of peer review is to improve the quality and safety of care. Secondarily, it serves to reduce the organization's vicarious malpractice liability and meet regulatory requirements. In the US, these include accreditation, licensure and Medicare participation. Peer review also supports the other processes that healthcare organizations have in place to assure that physicians are competent and practice within the boundaries of professionally accepted norms.
== Overview == Clinical peer review should be distinguished from the peer review that medical journals use to evaluate the merits of a scientific manuscript, from the peer review process used to evaluate health care research grant applications, and, also, from the process by which clinical teaching might be evaluated. All these forms of peer review are confounded in the term Medical Peer Review. Moreover, Medical peer review has been used by the American Medical Association (AMA) to refer not only to the process of improving quality and safety in health care organizations, but also to process by which adverse actions involving clinical privileges or professional society membership may be pursued. In addition, peer review methods are frequently used by state medical boards with respect to licensing decisions and complaint investigation. They are also used by insurance companies with respect to credentialing and utilization management processes.
=== Medicine === In US hospital settings, clinical peer review encompasses a wide variety of activities, whose scope varies across institutions. Virtually all programs perform retrospective medical record review (aka, case review) of the quality of care. Most also include Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) required by the Joint Commission since 2007. Many also include the management of disruptive behavior (see ) and physician health programs. Routine clinical peer review activity (performance assessment) is typically organized separately from the credentialing/privileging process (competence assessment), but the results of peer review inform those decisions. From a legal and regulatory perspective, however, the line is blurred. The definition of a peer review body can be broad, including not only individuals but also (for example, in Oregon), "tissue committees, governing bodies or committees including medical staff committees of a [licensed] health care facility...or any other medical group in connection with bona fide medical research, quality assurance, utilization review, credentialing, education, training, supervision or discipline of physicians or other health care providers." Medical staffs generally rely on generic screens for adverse events to identify cases for peer review, even though that might not be the most efficient or effective method. These are generally applied through administrative data analysis, but referrals for peer review are frequently made by risk managers, nurses and medical staff. The median annual review volume is 1–2% of hospital inpatient admissions. Thus, case review may be the dominant form of adverse event analysis in US hospitals. Case reviews are typically conducted by individual reviewers, but in nearly 70% of hospitals, most reviews are presented and discussed in a committee prior to final decision-making. Nurses now participate on physician review committees in the majority of programs. This extends the trend of the past decade for adoption of multi-specialty representation in the direction of multi-disciplinary peer review. Some of these committees now routinely assess nursing care during the case review process and may even directly address all improvement opportunities.
=== Nursing === The American Nurses Association published the first definition of nursing peer review in 1988. It includes the following statements: