A robust clinical review process: The catalyst for clinical governance in an Australian tertiary hospital

Objective: To determine if a robust clinical review process can influence an organisation's response to adverse patient outcomes. Design and setting: Retrospective analysis of the activity and outputs of the Clinical Review Committee (CRC) of a university-affiliated tertiary hospital from 1 September 2002 to 30 June 2006. Main outcome measures: Engagement of clinicians (number on CRC, number interviewed for the clinical review process, number of specific referrals from clinicians); and numbers of cases reviewed, system issues identified, recommendations made to the hospital board, and ensuing actions. Results: A multidisciplinary CRC with 34 members established a robust clinical review process and identified 5925 cases for initial case review. Of these, 2776 (46.8%) fulfilled one or more of the specified criteria for adverse events and progressed to detailed review; 342 of these (12.3%) were classed as serious or major. A total of 317 staff (11%) were interviewed, and 881 system issues were identified, resulting in 98 specific recommendations being made to the Clinical Board and implementation of 81 practice changes (including seven hospital-wide projects) to improve patient care. Conclusion: A robust, multidisciplinary clinical review process with strong links to managers and policymakers can influence an organisation's response to adverse patient outcomes and underpin a clinical governance framework.