PROCESS>SCREEN: a new way to review and report mortality and morbidity issues in intensive care.

Abstract

INTRODUCTION: Ten percent of patients experience an adverse event in hospital and the mortality and morbidity (M&M) audit is a crucial way to learn from these. There is little published data on improving this process. Kattula et al developed a new tool for systematizing mortality review with the acronym PROCESS>SCREEN. The structure allows for standardized mortality review including classification of findings into 11 domains. There appears to be no similar tool that has been used in intensive care and we report our experience of its use. METHODS: A dedicated registrar was assigned to run meetings and record data. The PROCESS>SCREEN proforma was sent to treating ICU consultants. The PROCESS>SCREEN tool was used to guide discussion and categorize findings. Data was collated on an Excel spreadsheet and reported using appropriate descriptive statistics. RESULTS: From February to September 2016 there were 1597 admissions and 37 deaths. 25 potential system or management issues were identified in 21/37 (57%) of cases resulting in 10 specific recommendations. 4/10 (40%) of recommendations related to ICU care, these predominantly involved communication and escalation of care domains. 6/10 (60%) of recommendations related to processes external to ICU involving 7 domains. All 6 external issues were escalated to appropriate hospital committees however no feedback was received to confirm resolution of potential safety concerns. CONCLUSIONS: PROCESS>SCREEN is a simple, standardized process to report, classify, and monitor M&M results at unit, organizational, and potentially national level. Our experience has confirmed its utility in providing feedback at unit level, however further work is required to ensure appropriate feedback at organizational and national levels.