Retrospective reviews of patients records to identify adverse events has been important in providing an indication of the scale of harm to patients as a result of their healthcare treatment. The first of these, the Harvard Medical Practice study, was carried out in New York in the mid 1980s and provided evidence of the scale of harm to patients in hospital. These initial findings were substantiated in further studies in the United States, in Australia, the UK and various countries around the world.

The methodology was originally devised in San Francisco in the early 1970s for the Californian Insurance Feasibility Study and was refined for use in the Harvard study, the Quality in Australian Health Care Study and for studies in Utah and Colorado. Each study group made minor modifications, adding or subtracting specific questions, but maintained the basic format of the Harvard study. In our own retrospective case record review study in the UK we adopted the basic methodology provided by the American and Australian teams and benefited from their advice and experience. In light of our experience of both review and analysis we made revisions to the review forms to provide a stronger focus on causation and a more tightly structured format – the Modular Review Form 2 (MRF2).

Relevant publications

Academic papers describing development and application of the MRF2 or a modified version of it are also available:

Woloshynowych M; Neale G; Vincent C. Case record review of adverse events: a new approach. Qual Saf Health Care. 2003;12:411-415. (

Neale G, Chapman EJ, Hoare J, Olsen S. Recognising adverse events and critical incidents in medical practice in a district general hospital. Clin Med. 2006;6(2):157-62. (

Olsen S, Neale G, Schwab K, Psaila B, Patel T, Chapman EJ, Vincent C. Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time record review may all have a place. Qual Saf Health Care. 2007;16(1):40-4. (

Hogan H, Olsen S, Scobie S, Chapman E, Sachs R, McKee M, Vincent C, Thomson R. What can we learn about patient safety from information sources within an acute hospital: a step on the ladder of integrated risk management? Qual Saf Health Care. 2008;17(3):209-15. (

Chaboyer W, Thalib L, Foster M, Ball C, Richards B. Predictors of adverse events in patients after discharge from the intensive care unit. Am J Crit Care. 2008;17(3):255-63 (

Aranaz-Andrés JM, Aibar-Remón C, Vitaller-Burillo J, Requena-Puche J, Terol-García E, Kelley E, Gea-Velazquez de Castro MT, ENEAS work group. Impact and preventability of adverse events in Spanish public hospitals: results of the Spanish National Study of Adverse Events (ENEAS) Int J Qual Health Care 2009;21:408-414 (


Modular Review Form (MRF2) (PDF)


Please contact Maria Woloshynowych for further information about the MRF2.