• ACE in the News

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    A Comparison of Internal and External Peer Review

    By Donald R. Lilly, MD; and Stephen A. Lewis, MD

    Cardiac catheterization laboratories (CCLs) must adhere to strict standards of quality in order to maintain patient safety, increase the likelihood of successful outcomes, and ensure appropriate categorization of patients and documentation of procedures. When performed using a team-based approach, in an organization with bias-free reviewers that have expertise and resources, internal peer review can be a powerful quality improvement tool. Although many CCLs have established protocols for internal peer review, these may not be sufficient for ensuring adherence to multiple guidelines and national standards. In addition, internal peer review is often a reactive process, implemented in response to specific problems or adverse events. Furthermore, clinicians may be wary and distrustful of internal peer review processes due to the perception of bias or of reviewers’ “political” agendas.

    External peer review can provide valuable feedback regarding improvements in quality and hospital practices. It is critically important that an external peer review program be collectively viewed by the interventional cardiology team at any given institution as credible, proactive, objective, unbiased, nonpolitical, and conducted by reputable outside experts. In 2013, the Charleston Area Medical Center (CAMC) Health System selected Accreditation for Cardiovascular Excellence (ACE) for our National Cardiovascular Data Registry (NCDR) review, as well as in 2014 to provide external quality review services to our CCL. Most important to CAMC cardiology leadership was to select a service with external reviewers who are practicing cardiologists and highly knowledgeable about national standards and best practices. A critical element in the decision-making process was that reviews would be conducted in a blinded, randomized, and anonymous way, using standardized forms and protocols.