Measuring clinical audit and peer review practice in a diverse health care setting

A measurement system was devised to determine the extent of clinical audit and peer review across the Hunter Area Health Service, to compare changes over time and to assess the effect of the implementation of a policy on the conduct of patient safety meetings.

Two surveys were conducted over consecutive years (2001, 2002). A scoring system was developed based on a 12 point questionnaire. Ten points were given for a 'yes' response and zero for a 'no' response. Points were also given for frequency of meetings. Statistical analysis was by the Mann-Whitney U-test. The questionnaire included items on clinical indicators, management of issues arising and whether meetings are multidisciplinary, chaired and points for action minuted and followed up.

One-hundred and five units provided data for the 2001 survey (100% response rate) and 109 units provided data for the 2002 survey (100% response rate). There was a significant increase in the median score in the 2002 survey (median 101; interquartile range 72-113) when compared with the 2001 Survey (median 91; interquartile range 51-110; P = 0.016). There was an improvement of 9% in units scoring in the highest quartile (90-120 points) and a decrease of 5% in units scoring in the lowest quartile (0-29 points).

This methodology allows for the quantitative measurement of audit and peer review activities across clinical units. It might assist clinicians, professional colleges and departments of health in the further development of the recertification\revalidation process.