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From research to practice: results of 7300 mortality retrospective case record reviews in four acute hospitals in the North-East of England
  1. Anthony Paul Roberts1,
  2. Gerry Morrow2,
  3. Michael Walkley3,
  4. Linda Flavell2,
  5. Terry Phillips2,
  6. Eliot Sykes4,
  7. Graeme Kirkpatrick5,
  8. Diane Monkhouse3,
  9. David Laws6,
  10. Christopher Gray5
  1. 1 South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, UK
  2. 2 Clarity Informatics Ltd, Newcastle upon Tyne, UK
  3. 3 South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
  4. 4 Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  5. 5 County Durham and Darlington NHS Foundation Trust, Darlington, UK
  6. 6 City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
  1. Correspondence to Anthony Paul Roberts; t.roberts{at}


Introduction Monitoring hospital mortality using retrospective case record review (RCRR) is being adopted throughout the National Health Service (NHS) in England with publication of estimates of avoidable mortality beginning in 2017. We describe our experience of reviewing the care records of inpatients who died following admission to hospital in four acute hospital NHS Foundation Trusts in the North-East of England.

Methods RCRR of 7370 patients who died between January 2012 and December 2015. Cases were reviewed by consultant reviewers with support from other disciplines and graded in terms of quality of care and preventability of deaths. Results were compared with the estimates published in the Preventable Incidents, Survival and Mortality (PRISM) studies, which established the original method.

Results 34 patients (0.5%, 95% CI 0.3% to 0.6%) were judged to have a greater than 50% probability of death being preventable. 1680 patients (22.3%, 95% CI 22.4% to 23.3%) were judged to have room for improvement in clinical, organisational (or both) aspects of care or less than satisfactory care.

Conclusions Reviews using clinicians within trusts produce lower estimates of preventable deaths than published results using external clinicians. More research is needed to understand the reasons for this, but as the requirement for NHS Trusts to publish estimates of preventable mortality is based on reviews by consultants working for those trusts, lower estimates of preventable mortality can be expected. Room for improvement in the quality of care is more common than preventability of death and so mortality reviews contribute to improvement activity although the outcome of care cannot be changed. RCRR conducted internally is a feasible mechanism for delivering quantitative analysis and in the future can provide qualitative insights relating to inhospital deaths.

  • patient safety
  • morbidity and mortality rounds
  • quality measurement
  • performance measures
  • quality improvement

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors APR was responsible for the original study idea. All authors contributed to the design of the study. LF and MW conducted statistical analysis. All authors contributed to data interpretation. APR and GM drafted the manuscript, and all authors contributed to its revision.

  • Competing interests None declared.

  • Ethics approval Ethics approval was not sought as the data were collected under normal NHS Clinical Audit arrangements. Only case records were used to obtain data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data in this paper is reported in aggregate form. Patient-level data are not available outside the trusts who collected for Clinical Governance purposes.

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