SDS Accreditation Update

On-line or on paper — peer review is key

Review random cases as well as complications

Peer review is a key component of any credentialing and privileging process but it does require some effort if the outpatient surgery program is office-based, admit experts interviewed by SDS Accreditation Update.

If you have more than one surgeon on staff, you don't have to go to other practices for help, says Gail Lanter, CPC, administrator of East Cooper Plastic Surgery in Mount Pleasant, SC. "We have two anesthesiologists and two surgeons in our practice so they review each other's cases," she explains. When Lanter's office-based surgery program underwent its survey by the Joint Commission on Accreditation of Health Care Organizations, the surveyor was satisfied with this approach because the physicians review charts regularly, not just when there is a complication.

Office-based surgery programs accredited by the American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF), approach peer review differently from those accredited by Joint Commission or the Association for the Accreditation of Ambulatory Health Care, points out Geoffrey R. Keyes, MD, a surgeon in Los Angeles and member of the AAAASF board of directors. The AAAASF peer review process is handled with physicians setting up their peer review group on-line, then submitting the required number of cases for review through the on-line system, Keyes says.

"We require that six random cases and every case with a complication be submitted for review biannually in order to maintain accreditation," he says.

This on-line peer review allows AAAASF surveyors and officials to see that office-based programs are performing ongoing peer review activities rather than waiting until just before the survey to review charts, he explains.

A surgeon can set up his or her own peer review group by submitting the names of other physicians who have agreed to review the cases or by submitting the name of a third-party peer review organization, explains Keyes. The reviews center on patient safety issues such as documentation of the consent for treatment, history and physical, pathology and lab reports, and proper surgical procedures, he says. In addition to providing physicians with an ongoing method to conduct peer review activities, the centralized reporting mechanism also provides data for AAAASF to use in monitoring the safety of office-based surgery, he adds. Physicians who use several physicians outside their facility for peer review should have a standardized format to ensure consistency and the addressing of important issues, sources say.

Data collected by the AAAASF peer review system during 2001 and 2002 resulted in a report that showed only 299 unanticipated complications in more than 411,000 procedures and only seven deaths,1 Keyes adds, "This data is very important to be able to demonstrate the safety of office-based surgery when performed by board-certified surgeons in accredited programs."


  1. Keyes GR, Singer R, Iverson RE, et al. Analysis of outpatient surgery center safety using an Internet-based quality improvement and peer review program. Plast Reconstr Surg 2004; 113:1,760.


For more information about peer review, contact:

  • Geoffrey R. Keyes, MD, The Keyes Surgicenter, 9201 Sunset Blvd., Suite 611, Los Angeles, CA 90069. Telephone: (310) 859-9388. Fax: (310) 859-8951. E-mail: