Impact of the new medical examiner role on patient safety

Fletcher, Alan K.; Coster, Joanne; Goodacre, Steve

doi:10.1136/bmj.k5166

Cited by 10 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Analysis of ME reviews in one of the pilot services identified clinical governance issues in 4% of cases that attending doctors were unaware of, including system failures highlighted by bereaved relatives. 6 This is consistent with ME accounts of the value of feedback from relatives and represents a strength of this approach.…”

Section: Findings In the Context Of Relevant Researchsupporting

confidence: 79%

“…5 The ME role was introduced to provide scrutiny by an independent, senior doctor of all deaths not investigated by a coroner. 6 The Coroners and Justice Act 2009 provides the legal basis for this new role, but it is not yet a statutory requirement. 7 The main aims of the ME role are to ensure that the Medical Certificate of Cause of Death (MCCD) is as accurate as possible, that…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Qualitative exploration of the Medical Examiner role in identifying problems with the quality of patient care

2021

Self Cite

View full text Add to dashboard Cite

ObjectiveA national system of Medical Examiners (MEs) implemented in England and Wales from April 2019 was intended to ensure that every death receives scrutiny from an independent, senior doctor, resulting in early detection of problems in care. The aim of this study was to increase understanding of how the ME role operates to identify problems related to quality of patient care and to explore the potential for development to maximise learning opportunities.DesignA qualitative approach involved the use of semi-structured interviews. Data analysis employed a framework approach.SettingStudy participants were recruited from 11 acute hospitals in England, known to be operating an ME service.ParticipantsA purposive sample of 20 MEs and one ME officer.ResultsMEs brought different perspectives to the role based on their medical background. The process for identifying and acting on quality of care concerns was broadly consistent, with a notable consensus regarding the value of speaking to bereaved relatives. Variation was identified within and between services in relation to how core components are carried out and the perceived salience of information, which appeared to reflect individual and service preferences as well as different organisational pathways. ME services required flexibility to accommodate fluctuating demand, but funding arrangements imposed restrictions. The majority of MEs highlighted limited opportunity for formal team contact and a lack of meaningful feedback as limiting scope for development.ConclusionCore components of the ME role were being conducted, although individual and systemic variations in practice were identified. The discussion with bereaved relatives is a unique feature of the ME role and was considered highly valuable, both for the organisation and relatives. Further development could consider the impact of the variation identified and address mechanisms for feedback and shared learning.

show abstract

Section: Findings In the Context Of Relevant Researchsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Qualitative exploration of the Medical Examiner role in identifying problems with the quality of patient care

2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…To utilise better, this would require a degree of central organisation at regional or national level. The introduction of the Medical Examiner system, in England and Wales [15] may present an opportunity to do this but hitherto the focus has been almost entirely on patient satisfaction (or, more strictly, that of their relatives) and healthcare quality. Whilst important, this ignores the usages that mortality statistics have been put to, historically, to tackle other areas of public health such as health protection and health promotion, such as Clean Air Acts, following the 1953 London smog or the current tracking of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Who is dying from COVID-19 in the United Kingdom? A review of cremation authorisations from a single South Wales' crematorium

Salmon¹,

Monaghan²

2021

Epidemiol. Infect.

View full text Add to dashboard Cite

Only studies in the UK on individuals dying from coronavirus disease 2019 (COVID-19) in hospital have been published, to date. Cremation law requires collection of clinical information that can improve understanding of deaths in both hospital and community settings. Age, sex, date and place of death, occupation, comorbidities and where infection acquired was recorded for all deaths from COVID-19, between 6 April and 30 May, for whom an application was made for cremation at a South Wales' crematorium. Of 752 cremations, 215 (28.6%) were COVID-19 (115 (53.5%) male and 100 (46.5%) female). Median age was 82 years (youngest patient 47 and the oldest 103 years). Over half the deaths (121/215: 56.3%) were over 80 years. Males' odds of dying in hospital, rather than the community were 1.96 times that of females (95% confidence intervals (CI) 1.03–3.74, P = 0.054) despite being of similar age and having a similar number of comorbidities. Only 21 (9.8%) of 215 patients had no comorbidities recorded. Patients dying in care homes were significantly older than those dying in hospital (median 88 years (interquartile (IQ) range 82–93 years) vs. 80 years (IQ range 71–87 years): P < 0.0001). Patients dying in hospital had significantly more comorbidities than those dying in care homes (median 2: IQ range 1–3 vs. 1: IQ range 1–2: P < 0.001). Sixty three (29.3%) of infections were hospital acquired and a further 55 (25.6%) acquired in care homes. In a series, of hospital and community deaths, persons over 80 with an average two comorbidities predominated. Men were more likely to die in hospital. Half the infections were acquired in hospitals or care homes with implications for management of the pandemic.

show abstract

“…To utilise better, this would require a degree of central organisation at regional or national level. The introduction of the Medical Examiner system, in England and Wales 14 may present an opportunity to do this but hitherto the focus has been almost entirely on patient satisfaction (or, more strictly, that of their relatives) and healthcare quality. Whilst important, this ignores the usages that mortality statistics have been put to, historically, to tackle other areas of public health such as health protection and health promotion, such as Clean Air Acts, following the 1953 London smog or the current tracking of Covid-19.…”

Section: Discussionmentioning

confidence: 99%

Who is dying from Covid-19 in the United Kingdom? A review of cremation authorisations from a single South Wales’ crematorium

Salmon¹,

Monaghan²

2020

Preprint

View full text Add to dashboard Cite

Abstract Background: Covid 19 is pandemic in the UK. To date only studies in the UK on hospital deaths have been published in the peer reviewed literature. Legal requirements for cremation in England and Wales require the collection of information that can be used to improve understanding of Covid 19 deaths in both hospital and community settings. Aim: To document demographic and clinical characteristics, including likely place of infection, of individuals dying of Covid 19 to inform public health policy Design: A comprehensive case series of deaths from Covid 19 between 6 April and 30 May. Setting: A crematorium in South Wales Participants: Individuals for whom an application was made for cremation. Main outcome measures: Age, sex, date and place of death, occupation, comorbidities, where infection acquired. Results: Of 752 cremations, 215(28.6%) were Covid-19 of which 115 (53.5%) were male and 100 (46.5%) female. The median age was 82 years, with the youngest patient being 47 years and the oldest 103 years. Over half the deaths (121/215: 56.3%) were over 80 years. Males odds of dying in hospital, rather than the community were 1.96 times that of females (95% Confidence Intervals (CI) 1.03 -3.74, p=0.054) despite being of similar age and having a similar number of comorbidities. Only 21(9.8%) of 215 patients had no comorbidities recorded. Patients dying in nursing homes were significantly older than those dying in hospital(median 88y (IQ range 82-93y) v 80y (IQ range 71-87y): p<0.0001). Patients dying in hospital had significantly more comorbidities than those dying in nursing homes (median 2: IQ range 1-3 v. 1: IQ range 1-2: p <0.001). Conclusions: In a representative series, comprising both hospital and community deaths, persons over 80 with an average 2 comorbidities predominated. Although men and women were represented in similar proportions, men were more likely to die in hospital. Over half the infections were acquired in either hospitals or nursing and residential homes with implications for the management of the pandemic, historically and in the future.

show abstract

Impact of the new medical examiner role on patient safety

Abstract: Alan Fletcher and colleagues outline how the new medical examiner system could create a world leading mortality review system if implemented appropriately

Cited by 10 publications

References 7 publications

Qualitative exploration of the Medical Examiner role in identifying problems with the quality of patient care

Qualitative exploration of the Medical Examiner role in identifying problems with the quality of patient care

Who is dying from COVID-19 in the United Kingdom? A review of cremation authorisations from a single South Wales' crematorium

Who is dying from Covid-19 in the United Kingdom? A review of cremation authorisations from a single South Wales’ crematorium

Contact Info

Product

Resources

About