Talking to a practice manager who also happens to be a CQC inspector – expect an outstanding rating for that practice! – it seems that one of the areas practices frequently fall down on during inspections surrounds Significant Events.
“The variation in how these processes are managed in practices is stark,” we were told. “Yet it’s hugely important, as when I go on inspections approximately two hours can be spent on Significant Events.”
So what is involved in the Significant Event Audit and how can practices prepare for inspection day?
The Significant Event Audit explained
The RCGP says that Significant Event Audit (SEA) – also called Significant Event Review or Analysis – is an increasingly routine part of general practice. It is a technique to reflect on and learn from individual cases to improve quality of care overall. Significant event audits should form part of your individual and practice based learning and quality improvement.
Whether clinical, administrative or organisational, the significant event analysis process should enable your practice to answer the following questions:
- What happened and why?
- How could things have been different
- What can we learn from what happened?
- What needs to change?
A further worthwhile question is:
- What was the impact on those involved (patient, carer, family, GP, practice)?
As a result, the RCGP suggests that SEA team discussions should be a routine part of your practice’s quality improvement and clinical governance, and is an opportunity for the team to:
- discuss each stage in detail
- identify any learning needs
- identify actions to be taken and changes to be made, and agree how these will be processed
Nigel Sparrow, the Senior National GP Advisor and Responsible Officer at CQC adds: “Significant event analysis can be used to show quality improvement in the ‘safety’ domain of our GP inspection.
Examples of significant events can be very wide-ranging and can reflect good as well as poor practice. Examples could include new cancer diagnoses, coping with a staffing crisis, complaints or compliments received by the practice, breaches of confidentiality, a sudden unexpected death or hospitalisation, an unsent referral letter or a prescribing error.
SEA requirements for inspections
When it comes to inspections it’s crucial to view SEA as an important part of revalidation. CQC guidance points out that a GP’s revalidation portfolio will be expected to contain two SEAs per year, which equates to 10 SEAs per five-year revalidation cycle. If a practice has done no SEAs, it is likely that there is a cause for concern and should be investigated further.
SEAs should act as a learning process for the whole practice and individual SEAs can be shared between members of staff, including GPs. The focus of the SEA is that learning is disseminated within the practice; one that would be rated as ‘Good’ ensures that the learning involves the whole team and becomes embedded in everyday practice.
When an inspector calls
During an inspection an inspector will be looking at the seven steps involved in an SEA, which are as follows:
- All staff should be aware of and be able to prioritise a significant event.
- Information gathering. There should be evidence of information gathering, including factual information on the event such as personal testimonies, written records and other health care documentation. For more complex events, more in-depth analysis will be required.
- Facilitated team-based meeting should have occurred to discuss, investigate and analyse events. There should be evidence of the meeting regularly for the purpose of SEAs.
- Analysis of the significant event including – what happened and why? How could things have been different? What can we learn from what happened? Is change required, and if so, what needs to change?
- Agree, implement and monitor change. There are no fixed end-points; outcomes should be revisited and the implementation and success of any agreed changes monitored at pre-set intervals.
- Written records and all the processes of the SEAs should be written up to form a report. The SEA report is a written record of how effectively the significant event was analysed.
- Report, share, review. The SEA should be shared with all members involved in the significant event.
SEA is an important yet overlooked part of the CQC inspections. To help practices ensure they’re achieving high rankings, the RCGP has put together some detailed guidance for practices, which is worth taking a look at – click here for more.
Do you have any advice surrounding SEA? Have you achieved good ratings in an inspection for your work? We would love to hear your comments! Either comment below or take it to the Practice Index Forum here.