Retrospective case record review: a blunt instrument that needs sharpening
Retrospective case record review is a cumbersome and costly method of identifying adverse events. Although it has resulted in some very significant initiatives, more efficient methods of preliminary screening and more robust methods of contemporaneous record review are needed to enable medical directors and heads of clinical units to assess quality of care.
“Hospital medicine used to be simple, ineffective and relatively safe. Now it is complex, effective and potentially dangerous”.1 The medical profession has been slow to address the dangers. Modern medical practice took off after the Second World War and within a decade the increased risks of iatrogenic disease were recognised. It was reported that admission to hospital carried a 20% chance of a “noxious” episode (excluding those caused by inadvertent errors and postoperative complications!). However, the attitude was “the dangers are generally warranted by the benefits” and “to seek absolute safety is to advocate therapeutic nihilism”.2 It took claims of medical negligence by the public to rock the boat. Prompted by a tort system spiralling out of control, the insurance industry in California sponsored a study of the incidence and nature of adverse events based on retrospective case record review (RCRR).3 Despite the cumbersome and costly nature of RCRR, the method continues to be used, primarily as an epidemiological tool.
The basic review process has changed little. In phase I nurses or experienced hospital administrators are trained to identify case records that satisfy one or …
