ii . The VP of Quality and / or Quality Director will coordinate the exchange of information and payments with the designated coordinator for the professional external review company . iii . The PRC will provide the external reviewer written instructions including but not limited to : a ) The nature of the concerns , the name of the physician / APP under review ; and b ) The timeframe for expected review completion and provision of the report . iv . Final Determination : Upon receipt , the PRC will provide the external review to the hospital ’ s QPRC Chair , Chief of Staff , and the CMO / VPMA . It will then be shared with the QPRC for its usual review and determination , in substitution for an internal peer review . The final determination of quality of care is the purview of the QPRC .
7 . QPRC Referrals : a . MEC : The QPRC may refer concerns about a case , trend of cases , repeated rule violations or significant rate variations directly to MEC at any time when it determines that immediate action by the MEC may be necessary to ensure patient or staff safety . b . Risk Manager : The QPRC may refer concerns to the Risk Manager if an identified issue is believed to potentially expose the Physician / APP and / or Hospital to risk of liability . c . Medical Staff Departments , Sections , Committees or Practices : The QPRC may refer concerns of process , technique or practice to the appropriate Medical Staff Department , Section , Committee or Practice if it believes such a referral will be more effective and provide an improvement opportunity for the members of that group ( i . e . instructional or education ).
8 . Peer Review in Medical Staff Departments , Sections , Committees or by Medical Directors : a . Delegation : Medical Staff Departments , Sections , Committees or Medical Directors may be delegated the responsibility to perform peer review functions on a regular or an ad hoc basis . This peer review activity is performed on the behalf of the QPRC and is protected under Nevada Peer Review Statue . Examples include Trauma Committee , Emergency , Pathology , and Radiology peer review , as well as ad hoc requests for Medical Directors or specific Medical Staff physicians / APPs specifically requested to perform initial review of the quality-of-care concerns raised by complaints and grievances . Correspondence of such reviews should include statements of confidentiality . b . Processes and Scoring : The reviews delegated to Medical Staff bodies should use the same processes and scoring outlined in this policy . c . Biannual Summary Reports : Medical Staff Departments , Sections and Committees that have been delegated regular professional review activities , should provide biannual summaries of their review activities to the QPRC . Summaries should include , but not be limited to the following : i . Number of cases reviewed . ii . Case review determinations : a ) # Exemplary Care ; b ) # No concerns ; c ) # Minor Improvement Opportunity ; d ) # Moderate Improvement Opportunity ; and e ) # Major Improvement Opportunity . iii . Summary of significant system , process , or individual concerns and improvement activities .
9 . Educational case or M & M / CME reviews performed by Medical Staff are not considered peer review activities and are not required to follow the procedures in this policy . They are , however , considered hospital quality management activities for the purposes of confidentiality and discoverability in legal proceedings . These educational reviews are an integral part of performance improvement activities .