Royal College of Physicians awarded pioneering national Mortality Case Record Review Programme

Published: 16 Feb 2016

Today the Healthcare Quality Improvement Partnership (HQIP) is pleased to announce that it has awarded the contract to deliver the first ever national Mortality Case Record Review Programme to the Royal College of Physicians (RCP).

This pioneering programme aims to develop and implement a standardised way of reviewing the case records of adults who have died in acute hospitals across England and Scotland. Its main aim is to improve understanding and learning about problems in care that may have contributed to a patient’s death.

In addition, the programme will identify common themes, work with healthcare colleagues to rectify and address any deficiencies in patient care and, through continuous quality improvement, share best practice.
The RCP will deliver the programme in partnership with researchers at Yorkshire and Humber Academic Health Science Network (AHSN) who have already developed, tested and implemented a qualitative methodology for mortality review in 12 Trusts in Yorkshire. To ensure this work supports existing clinical governance processes in NHS Trusts, the RCP has partnered with Datix UK.

Professor Danny Keenan, Medical Director at HQIP said,

“The National Mortality Case Review Programme will enable hospital doctors and nurses, to review the progress of patients who have died in hospital, looking to see if things could have been done better so that hospitals can improve the quality of care and service they give to patients and their families. HQIP looks forward to working with the Royal College of Physicians to support them in their delivery of this programme on behalf of NHS England and the Scottish Government.”

Dr Kevin Stewart, clinical director of the RCP’s Clinical Effectiveness and Evaluation Unit (CEEU), said,

The RCP is delighted to be awarded this contract to deliver such a pivotal programme. Patients and their families have a right to expect complete openness and transparency when things go wrong and for healthcare professionals to address and correct any deficiencies in patient care. This work can help promote a culture of transparency, ensure continuous quality improvement in patient care and the RCP is proud to be leading it.

Dr Mike Durkin, NHS England Director of Patient Safety, said,

The RCP is ideally placed to lead on this work and help play a key role in supporting organisations to understand more about how to deliver safer care for our patients. The national Mortality Case Record Review Programme is being commissioned as just one element of a wide ranging programme of work by the Patient Safety Team in NHS England to support NHS organisations to reduce deaths due to problems in care.

Professor Jason Leitch, National Clinical Director Healthcare Quality, Scottish Government said,

“We share a vision with NHS Scotland for an open and learning culture and welcome the opportunity to be part of the Retrospective Case Record Review programme of work. We welcome the leadership and support for this programme from the RCP which complements a range of work underway in Scotland that aims to share good practice in care and support learning when things go wrong, through clear and transparent processes, clear communication, honesty and compassion.”

The RCP is working in collaboration with patient and professional organisations to deliver this work including: the Yorkshire and Humber AHSN, Action against Medical Accidents (AvMA), the Royal College of Physicians of Edinburgh (RCPE), Faculty of Medical Leadership and Management (FMLM), the Academy of Medical Royal Colleges (AoMRC), the Royal College of Nurses (RCN), Healthcare Improvement Scotland, and Datix UK, as well as aligning with the medical examiner’s office.