The Clinical Area Safety Assessment, a Peer Review of Safety across an Acute Trust

Susan Robinson, James Ward, Trevor Baglin, Susan Broster, Carol Heesom-Duff, Glenn Pascoe, Jag Ahluwalia



Most hospitals have developed processes to manage risk in a reactive manner. Few, however, have instituted proactive systems for the identification of latent risk that has the potential to cause harm.


To develop a process for the identification of potential risks to safety across all clinical areas of a hospital.


Every clinical department in Cambridge University Hospitals Foundation Trust (CUHFT) underwent peer assessment to confirm that the Trust’s processes for safety were in place and identify possible threats to the safety of patients. This assessment consisted of a number of elements that included review of routinely collected data, observed clinical care and a safety questionnaire. The methodology used to apply this process is described.


The outcomes of 33 clinical area safety assessments (CASA) are reported. No department was awarded unconditional accreditation nor have any had their service suspended. A number of recurrent issues emerged, the most common being that 31% of departments failed to fully comply with Trust requirements for governance and 12% needed to improve compliance with patient safety standards. Concerns related to documentation were identified in 11% of assessments. To date the programme has cost approximately £111,000 with each review requiring approximately 130 hrs to complete.


The CASA programme has offered an opportunity to improve standardisation in governance and optimise safety processes across our hospital. It has facilitated the dissemination of good practice amongst teams to resolve common problems. Suggestions as to how we plan to further refine this peer review process are offered.

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Journal of Hospital Administration

ISSN 1927-6990(Print)   ISSN 1927-7008(Online)

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