CEO Message | Physician Reviewers: Thank You for the Whole Story!

Tina Georgy, RN, MS

In court, witnesses are asked to tell the truth – the whole truth. In a similar way, you as CIMRO’s physician reviewers are witnesses to care and treatment provided at our client facilities and you are charged with telling the story – the whole story.

The Whole Story
The role of a PR is primarily educational. At times, that requires going beyond the letter of what you’re being asked, and addressing the spirit of the inquiry. What is the client really asking? Is there anything they’re not asking - but that they do need to know?

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To that end, it is not enough to answer questions with a yes/no.  With rare exception (EPPE reviews or spreadsheets that offer answer choices in drop-down menu), those questions demand rationale and elaboration. 

For example, almost every worksheet asks, “Was standard of care met?” While “yes” may be the correct answer, it does not tell the whole story.  What the client really wants to know is: WHY is “yes” the correct answer?

Each case is different, but ways to elaborate include answering the following:

• Were assessments and tests done/ordered appropriately?
• Were the results/findings correct?
• Were consultations timely and appropriate?
• Was clinical decision-making sound?
• Was the procedure indicated?
• Was the technique correct?
• Was the documentation satisfactory, good, or exceptional?
• Were discharge and plans for follow-up care appropriate?

Paint the picture of why and how you reached your conclusions.

Back it Up
Use reference materials whenever possible – and the assumption is this is nearly always possible. Suppose you have an OB case that asks about the physician checking the patient for dilation. There is no randomized, double-blind study describing how to do that.  And we don’t expect you to quote a textbook describing the procedure step-by-step.  BUT there likely is a guideline and/or articles that support your professional judgment on when the patient should have been checked, why it was or was not appropriate, etc.
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Key to writing an excellent review is having ALL the information you need to answer your questions and make your judgments. Ideally, the client sends all that information initially. But sometimes, for whatever reason, they don’t.  Assume NOTHING. If you send us a report stating that the test wasn’t ordered or that something is missing, we’re going to ask the client for the missing element. And if it’s available, we will present it to you and ask you to make any needed changes. It’s easier for everyone if you ask for anything you need before submitting the report.

Keep the Lines Open
Open lines of communication among the CIMRO staff and our PRs are critical. All should feel free to express any concerns/questions as we prepare a final product a facility may use to make potentially career-altering decisions. CIMRO staff are always available to help solve problems and answer questions. Give us a call, and we will find you a solution.
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A Note of Thanks
The backbone of CIMRO’s external review programs is its 450 clinical peer/physician reviewers.  Without our PRs, CIMRO would not have the ability to offer healthcare facilities and systems the needed services of an unbiased, objective review to support their quality improvement programs. 

We can’t thank you enough for all you do for CIMRO. We fully realize that you are more than busy with your active practices and your personal lives. Your time and efforts are valuable and that is not lost on us. You are critical members of a team that seeks to ensure safety and best care for “our” patients and to educate providers and facility decision-makers. YOU MAKE A DIFFERENCE!