We read with interest Fletcher’s editorial on ethics approval for all studies involving human participants as a condition of publication, and the importance of having this done by ethics review boards as knowledgeable and unbiased third parties.1 As noted, although this approach is now standard for experimental studies, the practice for observational studies is inconsistent, and there are calls for exemption from ethics review for quality improvement, practice audits and similar endeavours.
Fletcher points to streamlined ethics review processes introduced in New Zealand and the United Kingdom. There is also a Canadian solution. Public Health Ontario has developed a process wherein all studies involving human participants receive an initial risk screening to determine the required level of ethical scrutiny.2 Similar to the New Zealand protocol with 24 questions,3 the Public Health Ontario process involves a 20-item risk-screening tool, which sorts projects into one of four review levels: full ethics board review, a conventional delegated review process, an expedited delegated review process or no further review with periodic audit (manuscript currently under review).
This approach supports CMAJ’s desire for an expanded yet balanced scope of ethics review and is broadly applicable in other settings where quality improvement and other observational studies are conducted.