Morbidity Mortality Readmissions Referrals GICU M&M&R&R Meetings Morbidity Mortality Readmissions Referrals

Aims Identify governance issues Open discussion among the team on quality of clinical care Possible care process redesign and policy update Education

Classification reviewed by consultant of the week Classification of events & deaths Classification reviewed by consultant of the week Weekly presentation No Concerns 1 Slide: Standard template Presentation updated with issues “O” Drive Expanded case review Incident Report Concerns Weekly Monthly Monthly report compiled Education & Governanace issues identified Care Group Meeting Consultant Meeting Other output/ plan

M&M&R&R Presentation Weekly: Every Wednesday (Tuesday on last week of the month) 8.30-9.00 GICU Seminar Room All staff welcome Trainee presenting expected to update slides with relevant issues and send them to consultant team via stgh-tr.gicu@nhs.net for upload to O drive Rota of individuals responsible set in advance and available on Yammer and GICU website Templates are HERE

Morbidity events Anything that was a near miss or actually resulted in patient (or staff) harm Very brief contextualised summary Datix completed Y / N Actions / learning points Duty of candour fulfilled Y/N

Mortalities Classification of death Action for each classification No Concerns Standard template slide in weekly presentation Concerns (pre GICU & / or in GICU) Standard template + Expanded case summary

Standard Template Slide – No concerns Initials, MRN, Age Date of Death, duration of stay Main reason for admission Relevant diagnoses Any end-of-life care issues? (Including organ donation) Death Certificate (if issued): I a b c II Check that there is an Episode Summary on iCLIP (or referral to coroner template uploaded to iCLIP)

Expanded case summary – Some concerns Complete standard template slide THEN Background / clinical presentation / management / HIGHLIGHT CONCERNS Concise, concentrating on major issues / events Open discussion RECORD - Lessons learned identified (added to presentation)

Lesson learnt / Actions to take place: Datix form completed? Feed back to admitting team? Y / N

Readmissions How many? For each instance Initials, MRN, Age How long between ICU step down and readmission? Was readmission Elective (planned) OR Emergency (unplanned) Preventable (Predictable) OR Unpreventable Any concerns / issues? Any lessons learnt / actions to be taken

Referrals How many? Any concerns / issues / themes? Any lessons learnt / actions to be taken?

Minutes Standard Excel Sheet To be filled in by trainee presenting Includes Attendance register Minutes file and Presentation to be sent by email to stgh-tr.gicu@nhs.net

Monthly report to Care Group Meeting Presents M&M data from previous month Total number Classification Learning points identified Governance issues identified/ proposed action Feedback on action items from previous report

Monthly: Case presentations; jointly with ED Once a month (4th Wednesday) One hour meeting: 8.00-9.00 University Lecture Theatres Expanded case summary + / - mini topic review

Team & Responsibilities Consultant of the week Chair the meeting held on your GICU (Red) Week Reviews classification of death for all patients Identify Morbidity that warrants referral to M&M&R&R meeting Registrar of the week Compiles mortality and prepares presentation based on guidance above Liaison with consultant re “concerns” in care and cases of significant Morbidity If registrar is not presenting, supervises trainee presenting in preparing an appropriate presentation All trainees will be expected to present at least one M&M meeting EM Trainees will prepare a case for the monthly joint meeting