School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.
BMJ Open. 2021 Feb 5;11(2):e048007. doi: 10.1136/bmjopen-2020-048007.
A national system of Medical Examiners (MEs) implemented in England and Wales from April 2019 was intended to ensure that every death receives scrutiny from an independent, senior doctor, resulting in early detection of problems in care. The aim of this study was to increase understanding of how the ME role operates to identify problems related to quality of patient care and to explore the potential for development to maximise learning opportunities.
A qualitative approach involved the use of semi-structured interviews. Data analysis employed a framework approach.
Study participants were recruited from 11 acute hospitals in England, known to be operating an ME service.
A purposive sample of 20 MEs and one ME officer.
MEs brought different perspectives to the role based on their medical background. The process for identifying and acting on quality of care concerns was broadly consistent, with a notable consensus regarding the value of speaking to bereaved relatives. Variation was identified within and between services in relation to how core components are carried out and the perceived salience of information, which appeared to reflect individual and service preferences as well as different organisational pathways. ME services required flexibility to accommodate fluctuating demand, but funding arrangements imposed restrictions. The majority of MEs highlighted limited opportunity for formal team contact and a lack of meaningful feedback as limiting scope for development.
Core components of the ME role were being conducted, although individual and systemic variations in practice were identified. The discussion with bereaved relatives is a unique feature of the ME role and was considered highly valuable, both for the organisation and relatives. Further development could consider the impact of the variation identified and address mechanisms for feedback and shared learning.
自 2019 年 4 月起，英格兰和威尔士实施了国家法医系统（MEs），旨在确保每一例死亡都由独立的资深医生进行审查，从而及早发现护理中的问题。本研究旨在增进对法医角色运作方式的理解，以发现与患者护理质量相关的问题，并探讨最大限度地利用学习机会进行发展的潜力。
采用半结构式访谈的定性方法。数据分析采用框架方法。
研究参与者是从英格兰 11 家已知提供法医服务的急性医院招募的。
选择了 20 名法医和 1 名法医官员作为目的性样本。
法医根据其医学背景为该角色带来了不同的视角。确定和处理护理质量问题的过程基本一致，在与悲痛的家属交谈的价值方面达成了显著共识。在核心组件的执行方式和信息的感知重要性方面，服务之间和服务内部存在差异，这似乎反映了个人和服务偏好以及不同的组织途径。法医服务需要灵活性以适应波动的需求，但资金安排却施加了限制。大多数法医强调正式团队联系的机会有限，缺乏有意义的反馈，这限制了发展的范围。
法医角色的核心组件正在执行，尽管在实践中存在个体和系统的差异。与悲痛的家属进行讨论是法医角色的一个独特特征，被认为对组织和家属都非常有价值。进一步的发展可以考虑到所确定的差异的影响，并解决反馈和共享学习的机制。
