Objectives;

• Describe the process of SEA
• Demonstrate how it might be used in our practice

Reflection Stop What makes you change the management of a patient? What reinforces your approach to problems? How do you share these with the other members of the practice? What is the result of this sharing?

Every week we will come across an event that will make us stop and think about

• How it happened
• What was the result
• Could it have been prevented
• Could it have been handled differently
• What should we do next time

We often discuss these with other people informally in corridors and over coffee in the morning. This may result in individuals changing their behaviour but is often lost due to the frantic nature of morning coffee!

SEA allows individuals and practices to reflect together on important events and discuss these openly in order to improve the quality of care that we provide to our patients.

SEA:

• provides structure to case discussion
• there is clear purpose in the way that it is performed
• reveals problems
• challenges the practice team
• reveals differences in the ways individuals manage the same situation

What are the results of a SEA

• Celebration on a "job well done"
• No Action where none is required
• A conventional audit
• Immediate change when required

Reflection Stop What is a significant event?

This is up to the individual/practice to decide.

Choosing Events.

• Important in the life of the practice
• Offer some insight into the care the practice provides

Events can include:

• Preventative care
• Acute Care
• Chronic disease
• Organization

How can SEA be organised within practices?

1. Each member of the practice should be confident that they are able to discuss the care they provide with their colleagues in a mature manner
2. There must be commitment from the practice team and time needs to be set aside. A suggestion is that 1 meeting of an hour duration per two months may be all that is required
3. Need to have a "chairman" to motivate other members of the team to record S.E. and arrange meetings
4. Need to appoint a secretary to take notes

Meetings agenda.

1. Review of previous meeting(s) and decisions
2. Case presentations
   Concentrate on the facts of the case to begin with, keeping questions and interruptions to points of clarification. Then look at details of each case.
   
   (a) Review acute care/immediate problems

• Positive aspects of care
• Aspects needing improvement

• Positive aspects of preventative care
• Aspects needing improvement

• Positive aspects of case
• Aspects needing improvement

• These should reflect changes in policy or procedures designed to remedy any deficiencies in the quality of care exposed by the audit

1. Record key issues in minutes of the meeting
2. Date and time of next meeting.

Why bother?

1. It is enjoyable
2. It is challenging
3. It complements other quality activity
4. It can effect real change

Reference: Pringle M, Bradley CP, Carmichael CM, Wallis H, Moore A. Significant Event Auditing. RCGP Occasional Paper 70. 1995.

Francisco Machado 13 October 2000