Reviewing recommendations of root cause analyses

Objective: To determine the opinion of medical and nursing clinicians of recommendations arising from root cause analyses (RCAs) conducted between 1 April 2003 and 30 September 2004 in one Sydney Area Health Service. Methods: Twelve doctors (response rate 86%) and 17 nurses (response rate 100%) reviewed 328 recommendations arising from 59 RCAs and completed a self-administered survey. Results: Nurses were significantly more likely than doctors to rate recommendations made by the original RCA team as "relevant to the causal statement", "understandable", "measurable" and "achievable". Doctors and nurses involved in the original RCA were significantly more likely to state that recommendations would "eliminate" or "control" the risk of a similar event occurring in the future. Conclusions: This is one of the first studies to analyse RCA data at the area health service level. That nurses reviewed recommendations more favourably may have implications for successful adoption of recommendations at the clinical level. We recommend further detailed analyses of recommendations arising from RCAs in order to determine their usefulness to inform strategies for improved patient safety