Significant event audit (SEA)

Significant event audit or analysis (SEA) 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 analysis provides the opportunity of using events in practice as a personal learning opportunity for the healthcare professional.

By reflecting on a chosen event and learning from the event this should lead to improved patient care. The chosen event may be to do with patient care (clinical event), something that has happened within the team (management event), a training event or just an event within your practice that was significant to you and that you wish to build upon and learn from.

For more information go to:

• RCGP: Significant event audit
• National Patient Safety Agency: Significant event audit
• National Patient Safety Agency: A quick guide to conducting a significant event audit

Suggestions and actions

Consider performing a significant event analysis on patients presenting with musculoskeletal pain who were subsequently diagnosed with cancer.

• Could the diagnosis have been made earlier?
• Were red flags present?

Given the importance of early diagnosis in inflammatory arthritis, with the optimal time for commencing DMARDS within 12 weeks of disease onset, early referral of patients with suspected inflammatory arthritis to secondary care is recommended. If you have a patient diagnosed with a connective tissue disease or inflammatory arthritis, consider a case note review to see whether the referral was organised in a timely manner (i.e. within 6 weeks of developing symptoms).

• What features in the history prompted the referral?
• Were investigations initiated in primary care and if so were they helpful?

Long-term work absence is a significant event. Consider a review of a patient presenting with musculoskeletal pain who has required prolonged sickness certification (Resource: Healthy Working UK).

• Could anything have been done to facilitate their return to work?
• Were psychosocial flags assessed and if so were they documented and formally addressed?
• Could a ‘fit note’ have been used to facilitate return to work?