Education And Debate

How To Do It: Use facilitated case discussions for significant event auditing

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7000.315 (Published 29 July 1995) Cite this as: BMJ 1995;311:315
  1. L A Robinson, general practice facilitatora,
  2. R Stacy, research associatea,
  3. J A Spencer, senior lecturera,
  4. R S Bhopal, professorb
  1. aDepartment of Primary Health Care, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
  2. bDepartment of Epidemiology and Public Health, University of Newcastle upon Tyne
  1. Correspondence to: Dr Robinson.
  • Accepted 24 March 1995

An important type of review undertaken routinely in health care teams is analysis of individual cases. This informal process can be turned into a structured and effective form of audit by using an adaptation of the “critical incident” technique in facilitated case discussions. Participants are asked to recall personal situations that they feel represent either effective or ineffective practice. From such review of individual cases arise general standards to improve the quality of care. On the basis of a study of audit of deaths in general practice, we describe how to implement such a system, including forming and maintaining the discussion group, methodology, and guidelines for facilitators. Problems that may arise during the case discussions are outlined and their management discussed, including problems within the team and with the process of the discussions.

Medical audit has traditionally taken place within a group composed of members of the same clinical specialty. However, multidisciplinary teamwork is usual in health care, so clinical audit may be a more effective means of bringing about change within organisations.1 2 One informal but important type of review that is routinely carried out within clinical teams is analysis of individual cases—for example, as an educational exercise (“random case analysis”) in vocational training in general practice and as a discussion between general practitioner and district nurse after the death of a terminally ill patient. This informal process can be turned into a more structured (and acceptable) method of internal audit using an adaptation of the “critical incident” technique,3originally developed in the 1950s.4 Critical incidents are collected by asking participants to recall situations that they think are examples of good or bad practice in the particular setting being studied. The participants describe what first occurred, the subsequent events, and why they perceived the incident to …

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