Article Text

Download PDFPDF
A structured judgement method to enhance mortality case note review: development and evaluation
  1. Allen Hutchinson1,
  2. Joanne E Coster1,
  3. Katy L Cooper1,
  4. Michael Pearson2,
  5. Aileen McIntosh1,
  6. Peter A Bath3
  1. 1Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  2. 2Department of Clinical Evaluation, University of Liverpool, Liverpool, UK
  3. 3Information School, University of Sheffield, Sheffield, UK
  1. Correspondence to Professor Allen Hutchinson, Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent St., Sheffield S1 4DA, UK; allen.hutchinson{at}


Background Case note review remains a prime means of retrospectively assessing quality of care. This study examines a new implicit judgement method, combining structured reviewer comments with quality of care scores, to assess care of people who die in hospital.

Methods Using 1566 case notes from 20 English hospitals, 40 physicians each reviewed 30–40 case notes, writing structured judgement-based comments on care provided within three phases of care, and on care overall, and scoring quality of care from 1 (unsatisfactory) to 6 (very best care). Quality of care comments on 119 people who died (7.6% of the cohort) were analysed independently by two researchers to investigate how well reviewers provided structured short judgement notes on quality of care, together with appropriate care scores. Consistency between explanatory textual data and related scores was explored, using overall care score to group cases.

Results Physician reviewers made informative, clinical judgement-based comments across all phases of care and usually provided a coherent quality of care score relating to each phase. The majority of comments (83%) were explicit judgements. About a fifth of patients were considered to have received less than satisfactory care, often experiencing a series of adverse events.

Conclusions A combination of implicit judgement, explicit explanatory comment and related quality of care scores can be used effectively to review the spectrum of care provided for people who die in hospital. The method can be used to quickly evaluate deaths so that lessons can be learned about both poor and high quality care.

  • Chart review methodologies
  • Quality improvement methodologies
  • Healthcare quality improvement
  • Patient safety
  • Qualitative research

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.