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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
Peer Review
Colleagues Evaluate Each Other’s Work
Compliments the supervisor’s review of documents and images
Types of peer review activities
— Regular agenda activity at team meeting
— Random cases distributed to group
— Group review of same case
— Sub-group (often pairs) reviews each other’s work and gives feedback
Peer Review: Caveats
SAFE Team Quality Assurance
Operational Issues
Chart Reviews
Medical and forensic records
— Legible
— Complete
— Accurate
— Concise
Adherence to forensic exam protocol
Response times/ resource utilization
Image management system
Professional Issues
— Physical findings
▪ Accurate identification
▪ Correct terminology
— Evidence management
— Forensic photography
— Clinical judgment
▪ Medical
▪ Forensic
Examiner Team Evaluations
Chart review system
Peer review system
Continuing Education: keeping examiners current
Courtroom performance
What is Reviewed?
Chart Reviews
— Forensic forms
— Narrative or addendum
— Forensic images
Associated material
— Medical record/ED report/hospital labs
— Crime lab results/reports
— Court testimony (transcript)
Who gets reviewed?
— New examiners
— Established examiners
— High-profile charts
— Problematic cases
— Random review of all examiners
Commonly reviewed items and issues
— Medical screening exam
— Consents signed
— Evidence collection and handling
— Injury descriptions
— Documentation complete
— Medical decision-making
— Forensic imaging documentation and quality
— Follow-up and referrals
— Signatures
Types of audits
— Comprehensive
— Focus (specific topics)
— Forensic images
— Medical issues
— Evidence management
Types of feedback
— Supervisor to individual
▪ Discussion and accountability
— Supervisor to examiner group
▪ Discuss trends, policy and training
— Reports
Factors for corrections and changes
— Written policies and guidelines
— Formal documentation
— Agreement and accountability
▪ Examiner
▪ Supervisor
— Notification of appropriate stakeholders
— System must address both written documents
and forensic images
Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Discovery issues
— Candid review of performance, problems and deficiencies is essential and must be protected
— Consider a medical quality assurance format
— Be aware of confidentiality to HIPAA
Peer review is PART of quality assurance…not the total program
— The key is the inclusion of EXPERTISE
SAFE Team Quality Assurance: Evaluating the Evaluators
How do you find “experts” to check the checker?
Input from other multidisciplinary members
Evaluate credentials, experience and certifications
Multi-center comparative reviews
Independent expert program audits
Supervisor and Peer Review Logistics
• Individual feedback
• Regular team meetings
• Regional examiner organizations
• Feedback, changes, accountability and acknowledgement must be documented
SART Quality Assurance
Feedback from Community Team Members
Law enforcement
— Notification
— Response times
▪ To victim
▪ To exam site
— Interactions with
▪ Examiner
▪ Exam facility staff
— Examiner performance
▪ Timely response
▪ Pre-trial conference
▪ Testimony (competency and accuracy)
— Legal outcomes
Quality Assurance for Sexual Assault Services