A structured judgement method to enhance mortality case note review: development and evaluation

Abstract

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Impact of the new medical examiner role on patient safety

“…The Care Quality Commission now requires all acute hospital trusts to be able to “say something about every death.” In March 2017 NHS England launched the Learning from Deaths initiative,15 which required acute hospitals to undertake case record reviews on selected cases based on criteria most likely to yield opportunities for learning, reflection, and improvement. NHS England did not stipulate any particular method for case record review, but recommended structured judgment review 16. This uses a standardised clinical judgment based method and involves trained clinical reviewers making explicit quality and safety judgments, scores, and comments about the care provided, using a phase of care approach.…”

Learning from hospital mortality

“…20 Standardised structured approaches have been developed to reduce subjectivity of case record review, including the IHI Global Trigger Tool, 21 the PRISM methodology 9 and Structured Judgement Review (SJR). 22 SJR is currently being used by the Yorks and Humber Improvement Academy, who have trained multidisciplinary teams of reviewers in 12 hospitals in England (Hutchinson, personal communication), and it will form the basis of a national mortality review programme being led by the RCP for the NHS in England and Scotland. 23 RCRR is labour intensive but, as a qualitative methodology, it works well because breakdowns in processes of care are common, and it only takes review of a small number of cases before themes start to emerge, especially if data from other sources, like incident reports, are considered.…”

Stroke mortality audit using the Structured Judgement Review method

“…Case notes were analysed using the SJR developed as part of the RCP 2016 National Mortality Case Record Review Programme. 2,3 The SJR is a two stage review process which has been validated and used in practice within a large NHS region. 2 The review requires an assessor to provide judgement scores on care provided at different phases of the patient journey.…”

“…2,3 The SJR is a two stage review process which has been validated and used in practice within a large NHS region. 2 The review requires an assessor to provide judgement scores on care provided at different phases of the patient journey. Phases of patient care include: admission and initial care, perioperative and procedural care, ongoing care, and end-of-life care (or discharge care.)…”

“…The review made use of the Structured Judgement Review (SJR) process introduced by the Royal College of Physicians (RCP). 2 This report discusses the mortality review methodology, its results, and local implications for stroke care.…”