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.

The Role of the Independent Reviewer is Threefold:

• To review facts independent of the health care team and impartially assess said facts and objective data regarding a diagnosis and treatment course.
• To provide clinical expertise and insight regarding complaints about the practice of medicine.
• To establish whether a departure from the “standard of care” occurred.

An independent pediatric medical file review can be used in a variety of situations.

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 attorney with a team member who is 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.

Our Pediatric Medical File Review Includes the Following:

• Review of medical issues and facts prior to conferencing.
• Medical Chronologies: concise medical timeline of events written in a way that a layperson can understand, without medical jargon.
• Timelines of critical events or key events.
• Identification of areas of liability, causation, and damages.
• Identification of mitigating factors surrounding an illness or injury.
• Research into all relevant medical literature about your case.
• Organization of medical records, indexing, and summaries, if needed.
• Participation in client interviews, if asked.
• Assisting with deposition preparation if needed.
• Identification of potential care providers at risk and appropriate standards of care.
• Assessing the completeness of medical records.