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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
Peer Review
Colleagues Evaluate Each Other’s Work
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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
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SAFE Team Quality Assurance
Operational Issues
Chart Reviews
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Medical and forensic records
— Legible
— Complete
— Accurate
— Concise
Adherence to forensic exam protocol
Response times/ resource utilization
Image management system
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Professional Issues
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Documentation
— Physical findings
▪ Accurate identification
▪ Correct terminology
— Evidence management
— Forensic photography
— Clinical judgment
▪ Medical
▪ Forensic
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Examiner Team Evaluations
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Chart review system
Peer review system
Continuing Education: keeping examiners current
Courtroom performance
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What is Reviewed?
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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
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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
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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
•Telemedicine
•Consultation
• Feedback, changes, accountability and acknowledgement must be documented
SART Quality Assurance
Feedback from Community Team Members
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Law enforcement
— Notification
— Response times
▪ To victim
▪ To exam site
— Interactions with
▪ Examiner
▪ Exam facility staff
Prosecutors
— Examiner performance
▪ Timely response
▪ Pre-trial conference
▪ Testimony (competency and accuracy)
— Legal outcomes
Quality Assurance for Sexual Assault Services
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