Expert Clinical Reviews: Introduction
The Review would like to receive clinical advice upon the management of children’s care by the paediatric cardiac service at Bristol, when a child’s care raises complex clinical issues.
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- Who are the experts?
- What will they look at?
- What questions are the experts answering?
- What use will be made of the experts’ reports?
- Options for receiving the report
- How long will this all take?
- Is this the only form of expert review taking place?
Who are the experts?
A review would be carried out by:
Paediatric Cardiology: Dr Frances Bu’Lock
Paediatric Cardiology: Dr Janet E. Burns
Paediatric Cardiac Surgery: Mr Asif Hasan
Anaesthetics and Intensive Care: Dr Ian James
Paediatric Intensive Care: Professor Ian Murdoch
Nursing Care: Mrs Pauline Whitmore
Nursing Care: Ms Elizabeth Leonard
Full details about these seven clinicians are available here.
If necessary, further experts may be asked to advise (e.g., perfusionists, paediatric intensive care consultants, paediatric haematologists, etc). If this occurs, you will be given the name(s) of any proposed expert in advance.
All experts have agreed to advise the Review. They are independent of the Trust, and have declared no conflict of interest which would affect their suitability to act as an expert advising the Review.
What will they look at?
The experts will look at any statements, witness contact sheets or other types of information that you have provided to the Review. If you have asked questions about the care given to your child, the issues you have raised will be considered by the panel.
The experts will examine the clinical notes provided by the Trust and any other hospitals involved in your child’s treatment and care, together with any other information provided about the events that occurred. If you tell us that the clinical notes seem to be incomplete, or if you do not agree with what is said about particular events that you witnessed, they can take this into account.
We will also ask the experts to look at records of any investigations into events that occurred involving your child whilst in hospital or under the care of the paediatric cardiac services. An example would be a Root Cause Analysis (RCA). If an RCA was carried out, we would ask them to look at this, together with any comments that you or others had made about it.
What questions are the experts answering?
We are first asking the experts to examine the adequacy of the care received at the various stages of treatment. This will generally involve looking at pre-operative care and assessment, care during any procedures and post-operative care in both the PICU and Ward 32. No child’s care and treatment is identical to another child’s. The experts will therefore be looking at a different pattern of care in each case.
In addition, they will try to answer questions raised by family members with the Review about their child’s care. We cannot guarantee that they will be able to do so in every case – it will depend on the nature of the question and the information that is available to them. Sometimes, the answer to a question will be affected by uncertainties about facts which experts cannot resolve. But they will try to assist families with the major questions that they have about the care their children received.
The aim is to produce a single report to which all experts have contributed. If they reach different views, they will set them out in the report and explain why there is not a joint view. There may be times when it seems sensible for there to be a separate report from one expert; but if so we will ask all the others instructed to review it and say whether it means that they should change their views in any way.
In some particularly complex cases, we may first send a draft copy of any factual summary of events to the family, to the Trust and also to any clinicians at other hospitals if their contribution has formed part of that summary. We will ask for confirmation that the confidentiality of the draft will be respected before the draft is sent out. So if you think that the Review has made a mistake about any significant fact, you can tell us so. The experts will be asked to consider any comments received, to finalise their report.
What use will be made of the experts’ reports?
Because each report will contain confidential, sensitive information about patients, these individual reports will not be published by the Review. The Review will use the information provided by its experts to form views about the issues in its Terms of reference, but it will be very careful to respect children’s privacy and anonymity when making reference to any of this material in a final Report. The identities of the children will not be published.
A copy of the expert report will also be made available for the family members concerned to see.
Options for receiving the report
A copy of the experts’ report (or reports) will be made available to the family whose child’s care has been examined.
We also think that it would be fair to give a copy to the clinicians at the Trust. They will be expected to treat it on a patient- confidential basis.
Not everyone wishes to receive sensitive information by post or email. Before we send you a report, we will talk to you about how you would like to receive it. Some people may prefer to have a meeting with the Review at which any report is given to them, with an opportunity for discussion.
How long will this all take?
The first stage in any review is obtaining your consent to it, accompanied by agreement that we can obtain relevant clinical records from the Trust. We would also like to check that we have all the information that you think that our experts should be looking at (you may already have provided this).
After that has happened, we will seek copies of the medical records from the Trust or any other relevant healthcare provider. If there is relevant information sent to us which you have not had an opportunity to see before, we will check whether you wish to receive a copy and to have an opportunity to comment on it. Once the Review’s experts have access to all this material, we will ask them to consider the information available.
Because the reports will be used to help the Review to examine the paediatric cardiac service, we would expect to make them available to families at or around the same time as we publish our Report.
Is this the only form of expert review taking place?
No. The experts we have named above will also be helping us with some of the broader themes which are set out in our Terms of reference.
Although not all cases will involve complex clinical issues that need review by the whole team of experts, the Review is arranging for both its cardiologist and cardiac nurse advisers to review all the family statements or interview transcripts that have been provided to the Review by families to date. If they consider that an expert clinical review by the full expert panel or some members of the panel is required, then this will be offered to families and the necessary consent for access to clinical records will be requested.
In addition, the Care Quality Commission (CQC) is committed to carrying out a clinical case note review, looking at what the notes say about the care received by a number of children. We expect this work to be made available to the Review.