Peer review is a quality improvement and risk management process, the purpose of which is to protect patients from health professionals who have made poor management and treatment decisions. As the name implies, the concept of peer review is that the performance of one health professional is assessed by a group of his/her peers, or equals.
Peer review in medicine has been undertaken for many decades in a variety of guises. It may be a formal or an informal process; it may occur regularly or only in response to an identified problem; it may have implications for credentialing, scope of practice and remediation or as a routine component of the ongoing quality improvement program.
In radiotherapy, peer review is frequently carried out as an informal weekly process whereby all patients commencing radiation treatment are presented to a gathering of the radiation oncologists, radiation therapists and medical physicists in the centre. The patient's salient clinical features are presented, together with the management plan and some radiation treatment details. The participants provide feedback regarding the adequacy of the proposed management and/or treatment plan. In larger centres with subspecialist teams, peer review may be carried out within the subspecialist team. It is good practice to document the conclusions of any discussion.
At the other end of the spectrum, peer review is a formal process used to assess the competency of a health professional. This process may be a routine component of the organisation's quality improvement program, occurring every 1-2 years, or it may occur in response to an incident or complaint. A panel is convened to assess competency; this may include a retrospective review of the health professional's cases, or attendance at the health professional's clinics or procedures by a member of the peer review team, to observe the health professional's competency. In these circumstances the review process must be fair, unbiased and transparent, with the right of appeal.
It is important to emphasise that the function of peer review is to protect patients from harm. Each centres must determine the optimal manner to achieve this goal, within the local rules of the institution and the legislative framework of the country.