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

Abstract

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.

Is anybody ‘Learning’ from deaths? Sequential content and reflexive thematic analysis of national statutory reporting within the NHS in England 2017–2020

“…This could be due in part to NSCTs increasing awareness of the LfDs guidance for NHS trusts on working with bereaved families and carers, 8 more likely though is because of the increased establishment of ME Systems supporting the bereaved within NSCTs. 707 Further recognition of the need for and provision of training for healthcare staff with regard to bereaved relatives was identified by a few NSCTs. Despite evidence that patient and family engagement improve patient safety, many organisations still have difficulties achieving this.…”

“…There was an increase in reporting of ‘Lack of/problem with engagement with/support of families/carers’ from 4% in 2017/2018 to 28% in 2019/2020. This could be due in part to NSCTs increasing awareness of the LfDs guidance for NHS trusts on working with bereaved families and carers,8 more likely though is because of the increased establishment of ME Systems supporting the bereaved within NSCTs 707. Further recognition of the need for and provision of training for healthcare staff with regard to bereaved relatives was identified by a few NSCTs.…”

Is anybody ‘Learning’ from Deaths? Sequential content and reflexive thematic analysis of national statutory reporting within the NHS in England 2017-2020

“…This could be due in part to NSCTs increasing awareness of the LfDs guidance for NHS trusts on working with bereaved families and carers, [8] more likely though is because of the increased establishment of Medical Examiner Systems supporting the bereaved within NSCTs. [44] Further recognition of the need for and provision of training for healthcare staff with regards to bereaved relatives was identified by a few NSCTs. Despite evidence that patient and family engagement improve patient safety, many organisations still have difficulties achieving this.…”

End-of-life care quality measures: beyond place of death

“…For example, the current development across the UK of Medical Examiners (distinct to the American coroner role of the same name) offers promise, encompassing case-note review, discussion with the attending doctor and separately with the deceased's next of kin for all deaths (apart from those requiring compulsory referral to a Coroner such as suicide, trauma and sudden death). 78 Reviews of the UK ME initiative have already demonstrated the usefulness of incorporating next-of-kin views for identifying challenges in community end-of-life care provision 79 and in quality care at the end-of-life during the COVID-19 pandemic. 80 Moving beyond the flawed metric of place of death will not be straightforward, particularly in countries such as the UK where there is no national palliative care data collection system and a decentralised healthcare system.…”