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Mortality toolkit: Implementing structured judgement reviews for improvement

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The National Mortality Case Record Review (NMCRR) toolkit has been developed to support trusts in implementing a standardised way of reviewing the case records of adults who have died in acute hospitals across England and Scotland.

The toolkit supports the implementation of the Structured Judgement Review (SJR) process to effectively review the care received by patients who have died. This will in turn allow learning and support the development of quality improvement initiatives when problems in care are identified.

It also aims to improve learning and understanding about problems and processes in healthcare that are associated with mortality and share best practice.

Who will benefit from this toolkit?

The toolkit is for those wishing to implement the SJR process at a regional or local level, with specific reference to clinicians, managers, commissioners and trainers in secondary and tertiary care. It should also be useful as a reference for community and primary care providers.

How the SJR method works

An SJR is usually undertaken by an individual reviewing a patient’s death and mainly comprises two specific aspects: explicit judgement comments being made about the care quality and care quality scores being applied. These aspects are applied to both specific phases of care and to the overall care received.

The phases of care are:

  • admission and initial care – first 24 hours
  • ongoing care 
  • care during a procedure 
  • perioperative/procedure care
  • end-of-life care (or discharge care) 
  • assessment of care overall.

While the principle phase descriptors are noted above, dependent on the type of care or service the patient received not all phase descriptors may be relevant or utilised in a review.