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National Mortality Case Record Review Programme

What we are doing

After three successful years, the National Mortality Case Record Review Programme (NMCRR) ended on 30 June 2019, leaving a long-lasting legacy in patient safety.

For information on the RCP’s current patient safety workstream please visit the Patient Safety pages.

About the programme

The NMCRR Programme was awarded to the RCP in February 2016. It was funded by NHS Improvement and the Scottish Government, and commissioned by the Healthcare Quality Improvement Partnership (HQIP). The aims of the programme were to:

  • implement a standardised methodology to review care received by patients who had died
  • improve learning and understanding about problems and processes in healthcare associated with mortality, and to share best practice.

 

What the programme achieved

The NMCRR developed the Structured Judgement Review (SJR) process to effectively review care received by patients who had died. The SJR replaced variable local systems with a standardised, national, evidence-based method.

The SJR was implemented in over 120 acute NHS trusts in England and in a number of hospitals in Scotland. Over 600 healthcare professionals were trained directly by the NMCRR team as tier one trainers. These tier one trainers in turn trained thousands of clinicians throughout the NHS in England and Scotland to become hospital mortality reviewers.

Implementation of the SJR made positive contributions to improving healthcare for patients and demonstrated that quality improvements were possible as a result.

What we have produced

The National Mortality Case Record Review's annual report describes the programme's aims and objectives, along with its development and implementation.

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 NMCRR programme has been working with other nationally commissioned mortality review programmes and confidential enquiries to explore sharing intelligence and collaboration opportunities.
Watch our seminar 'Keeping patients safe – learning from mortality reviews to improve patient safety.'
The WEAHSN set out to encourage and support a collaborative approach to the mortality review process across NHS trusts in the west of England.