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04.10.18

Standardised hospital death reviews: RCP reports on ‘successful’ progress so far

Hospitals are now using a standardised review method to improve patients care and learn from adult acute deaths, a new report from the Royal Collage of Physicians (RCP) has revealed.

In March 2017, trusts across England were instructed to carry out mortality reviews after the publication of the National Quality Board’s (NQB) ‘Learning from Deaths’ – a move backed by the National Mortality Case Record Review (NMCRR).

Funded by NHSI and the Scottish Government in Scotland, the NMCRR programme was commissioned by the Healthcare Quality Improvement Partnership in 2016. The RCP’s programme developed the Structured Judgement Review (SJR) process to review the care that patients who have died received. This tool replaced the variable local systems of the time with a standardised model.

The NMCRR programme has now been actioned in more than 100 NHS trusts and boards and has trained roughly 480 healthcare professionals, who in turn shared their training with at least 1,500 others. 

The SJR has allowed for an insight into the care delivered to adult patients in the lead-up to their deaths in acute hospitals in a way that clinical coding and death certification data cannot. It also helped identify good practice to be spread across the NHS.

Today’s RCP report cites a number of cases in which the SJR contributed to the improved patients care, such as Buckinghamshire Healthcare NHS Trust, which in six months was able to inform improvement for end-of-life care (including bettering patient choice), encouraged the creation of personalised care plans, and rose awareness of appropriate ‘do not attempt CPR’ decisions.

Dr Andrew Gibson, consultant neurologist and clinical lead for the NMCRR, said: “This pioneering NMCRR programme aims to implement a validated, standardised way of reviewing the case records of adults who died in hospitals across England and Scotland.

“The report demonstrates that through using a standardised review approach NHS trusts can successfully improve quality in patient care and safety. It also highlights the significant efforts required to implement the programme nationally and the enthusiasm from those involved to work collaboratively.”

Professor David Oliver, clinical vice president of the Care Quality Improvement Department and consultant in geriatrics and general internal medicine at the Royal Berkshire NHS FT, added: “Nearly half of deaths in the UK happen in hospital and quite rightly there has been growing political and professional focus in recent years on improving end-of-life care, support for the bereaved, and learning from and ultimately eliminating preventable deaths.

“It is therefore really positive to see that the use of our SJR validated, structured tool is already contributing to positive changes.”

 

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