End of Life Care

Death Screening & Database Project

Mortality (or death) review is a process in which the circumstances surrounding the care of a patient who died during hospitalisation are systematically examined. While the majority of these deaths are expected and unavoidable, some are not. It is therefore important that all deaths are reviewed, withlessons learned and shared to improve care and avoid untimely death.

The development of a standardised approach to mortality review provides an opportunity to improve the work process for mortality review both at the local and State level in NSW. This includes: every death case reviewed; unnecessary deaths identified and analysed; improved work process such as referralto Special Committees; and instant comparison on mortality for clinicians, managers, and administrators at a local and Statewide perspective.

The NSW Health Patient Safety and Clinical Quality Program (PSCQP, 2005) requires each public health organisation to have in place a system for screening medical records of all patients who have died in their service. The intent of the process isto "ensure appropriate mandatory reporting and review of patient deaths; and determine whether changes in practice are needed to improve the safety and quality of patient care."

Death Screening and Review Tools

To support this process the CEC has developed an admitted patient death review screening tool.

The Admitted Patient Death Screening Tool aims to:
  • standardise measures of death review
  • provide local evidence of compliance with numerous NSW Health policy directives
  • provide Statewide information to drive improvement
  • provide evidence of compliance with actions in National Safety and Quality Health Service Standards
Other death review tools include:

Death Review Database

A web-based intranet online database (work flow management, data collection and analysis) has been developed to support the recommended standard of medical record screening. This provides a means to improve medical management and examine adverse events, complications, and errors that have led to illness or death in patients. The database has been rolled out to all local health districts.