Peer review as an aid to improving the completeness of psychiatric case notes

Clinical auditing and the setting of goals for continuing education are often based on case note reviews. Deficiencies in the comprehensiveness of the recorded case history place some restrictions on the usefulness of such reviews as guides to continuing education programmes. In this study, attempts were made to improve the quality of the data in psychiatric case notes by peer discussion, and by altering the case note recording guidelines. After each educational intervention a further detailed audit of the subsequent case histories was performed. Significant differences emerged in a few subsections of the case notes, but overall there was little change. Possible explanations for these findings are discussed.