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The new peer review process at Penn Medicine Lancaster General Hospital (LGH) is designed to increase legal protections and efficiency for physicians and advanced practice providers regarding matters that arise through the hospital.

Kenneth R. Arthur, M.D., President-Elect of the LGH Medical & Dental Staff, said the redesigned process represents a significant change from the past approach.

“Previously, close to 40 committees were doing what we called peer review,” he said. “Beginning this month, the Med Staff will have one major Peer Review Committee.”

The new committee, chaired by Justin Roberts, D.O., of The Heart Group, will hold its first meeting May 8. The committee’s 12 members include a representative from each Department, with Department Chairs and Division Chiefs serving as ad hoc members. Additional ad hoc members may be necessary from time to time, including experts in particular areas and members of the Quality team.

The committee will consider quality and safety issues involving physicians and APPs. The Medical Staff Office will continue to handle cases related to the Code of Conduct.

Dr. Roberts, who has served on several peer review committees at LGH, said the new committee will bring a more standardized, multidisciplinary approach to understanding opportunities to improve care delivery.

“Through the peer review process, we will examine opportunities for improvement in providers, as well as the system in which we practice,” he said. “I think the saying, ‘A rising tide raises all boats,’ is very fitting for the objective of this group.”

Increased Legal Protections Regarding LGH Matters

Previously, most LGH Departments and Divisions had their own peer review committees, in addition to others affiliated with service lines or multidisciplinary teams. These loose, often informal discussions could lead to discoverability of information and documents if the information was ever requested in litigation.  The new system will enable the hospital to better protect peer review information and ensure that the discussions and materials derived from just one committee are protected.

With regard to Lancaster General Medical Group, Katie Weinrich, Director & Senior Counsel, said the Reginelli case, which was recently heard by the Supreme Court of Pennsylvania, limited some previous peer review protections related to keeping information privileged and not discoverable for attorneys in legal cases.

“The Legal team and Quality have been working very closely in order to redefine the LGMG peer review process so that candid discussions around patient safety can still be held in a protected fashion,” she said.

Increased Efficiency for LGH Peer Review Matters

Dr. Arthur, of LG Health Physicians Plastic & Cosmetic Surgery, said that previously, a case sent to peer review could be passed to a series of committees and ultimately discussed by a group that did not necessarily represent all areas of the hospital. Resolution could take months.

“This new approach will reduce redundancy and make the process more efficient,” he said. “The diversity of backgrounds, experience and perspectives of the committee members should allow for more productive discussion and resolution of issues.”

A group of quality nurses will review potential cases and decide which are appropriate to send to the Peer Review Committee. Dr. Arthur expects the committee will consider about three to five cases per month.

Physicians or APPs involved in a case may be asked to submit a letter or attend a meeting to answer questions. After discussing the case, the committee will vote on whether it represents a minor issue, a major issue or no issue.  When the new policy is followed, all of these steps should be protected under Pennsylvania’s peer review privilege laws.

The Department Chair, Division Chief or the Med Exec Committee will handle follow up, which may include provider education. Very serious cases may be reportable.

“This is a pretty significant change for us,” Dr. Arthur said. “Just like anything else we do, we will look to continuously improve the process as needed as we go.”