A Pediatric Medical File Review involves evaluating a patient’s healthcare records for completeness and to provide an opinion for families to ask questions about care, looks for issues in the decision making or diagnostic issues regarding care and give families or attorneys an opinion about standard of care issues that can lead to harm or death of a child.
Medical records usually contain all the significant information about the patient’s diagnosis, medical and social history, and the various tests and imaging studies conducted. These may help a family understand issues surrounding a catastrophic illness of a child or death. Medical file review can answer questions they still have or fill in blanks that they cannot recall from those hours in the hospital. They can also be useful to insurance companies, attorneys, and risk managers.
Insurance Companies: An external medical record review is often the last part of an appeal process when an insurance company decides to pay a claim or deny a claim that they may consider outside of usual practice. External experts are used to assess the medical decision making of the treating physicians.
Risk Managers: To assess risk within the system they work for. To guide staff, practicing physicians and management when there is an adverse event often without or before any legal action being sought. These reviews help identify areas of vulnerability in the system that may have caused the adverse event, breaches in standards of practice and educational opportunities to prevent these events in the future. These reviews are most powerful when completed by an external, objective reviewer.
Peer Review: Practice issues within the purview of medical staff associated with physician practice or behaviors that affect practice often are difficult to deal with internally because colleagues are rue to speak ill of each other. The president of the medical staff or CEO often will use an external expert to offer an opinion and advice about these practice issues. This external review process avoids issues of subjectivity and bias.
Utilization Review (internal and external): may request assessment of decisions to keep patients in the hospital, requesting current literature and standards of care.
Families: When a child dies, family members can be faced with much confusion as well as myriad unanswered questions about the passing itself. They may have forgotten what the child’s physician told them or need clarification of events surrounding the child’s illness or death. The external reviewer can conduct a thorough pediatric medical file review to look at all the records, notes, and testing and help provide a comprehensive review of diagnosis, treatment, and adverse events. Answer questions and help with lingering doubts.
Attorneys: A medical review provides an assessment of the facts of the case, breaches in the standard of care, and proximate causes of injury or death. It identifies vulnerabilities in the case and provides you with a team member able to quickly answer questions with science-based answers and develop a case strategy.
Whether it be peer review, utilization review, medical necessity, or another type of file review Dr. Bartholomew and her team thoroughly conduct pediatric medical file reviews using her 35+ years of experience to provide timely and medically accurate information to our clients.
We conduct an in-depth review of the case and identify any areas of liability, causation and damages and assist in finding an attorney if needed.
We will conduct a thorough review and help assess the case. We’ll identify the strengths & weaknesses.