A review of the current evidence base for significant event analysis

To review the literature on the perceived benefits and disadvantages associated with significant event analysis (SEA) and identify reported barriers and facilitating factors.

A comprehensive search of electronic databases and peer reviewed journals was conducted during June 2006. Studies which explored or measured perceptions or attitudes in relation to SEA or assessed its impact on health care quality were included.

27 studies were identified with most undertaken in UK general practice. Perceived benefits include: improved communication, enhanced team-working and awareness of others' contributions. SEA has a strong emotional resonance which may lead to a greater commitment to change. Multiple but unverifiable changes in practice and improvements in service quality were reported through participation. Disadvantages include concerns about litigation, reprisal, embarrassment and confidentiality. The reliability of SEA is questioned because it lacks a robust, standard structured method. Evidence of its impact on health care is severely limited. Barriers include a lack of training, poor team dynamics, failings in facilitation and leadership, selective topic choice and associated emotional demands. Facilitating factors include: effective practice in meetings; protected meeting time; a structured methodical approach; and strong team dynamics and leadership.

A chasm exists between the high expectations for SEA and the lack of evidence of its impact. SEA may have some merit as a team-based educational tool. However, it may not be a reliable technique for investigating serious or complex safety issues in general practice. Policy makers need to be more explicit about the actual purpose of SEA.