Peer Review and Professional Practice Evaluation
Three peer review modes
Peer review evaluates the quality and appropriateness of care by practitioners with comparable training. The exam distinguishes retrospective case review, ongoing professional practice evaluation (OPPE), and focused professional practice evaluation (FPPE). OPPE is continuous, data-driven, and feeds reappointment; it should use metrics defined in advance. FPPE is time-limited and triggered by initial appointment, a new privilege, or a question about competence. The Joint Commission addresses these in MS.08.01.01 and MS.08.01.03.
Designing defensible FPPE
Write the plan before the evaluation begins: criteria, data sources, duration (commonly six months, not open-ended), proctoring or chart review, reporting frequency, and close-out decision. The same applies to proctoring agreements and external peer review. Confidentiality protections depend on state peer review statutes, so route documents through the peer review process rather than general files.
Worked example
A surgeon requests a new robotic-assisted procedure. The FPPE plan requires a proctor for the first ten cases, 100% chart review for the first twenty cases, and review of conversion and complication rates at six months. At close-out, the committee compares results with the pre-set criteria and recommends continuation, limitation, or additional monitoring. Reasoning: the decision rests on defined evidence, not impression, and the file shows the criteria, data, and rationale.
Traps that cost marks
Treating OPPE as a punishment tool; starting FPPE without written criteria; leaving FPPE open indefinitely; conflating peer review with disciplinary action; sharing peer review data outside protected channels; and drawing conclusions from unadjusted single cases.