SCOR - Standardised Clinical Outcome Review

SCOR is a web-based (NHS net) tool for comprehensive case review and action planning in response to perinatal deaths.

Overview With the help of wide stakeholder involvement, we have recently developed a new electronic tool (SCOR – Standardised Clinical Outcome Review) which helps clinicians to review the circumstances preceding and surrounding their stillbirths and neonatal deaths in a standardised way, and derive a taxonomy of substandard care factors which can lead to a systematic action plan. This tool is currently being piloted in 16 West Midlands units.

Background

The findings of a series of regional perinatal confidential enquiries ^{[1] [2]}showed wide variation of ways in which maternity units review and learn from such deaths. With support by West Midlands Chief Executives and the SHA, the Perinatal Institute started an initiative in 2010/11 to standardise the perinatal review process, and convened a regional multidisciplinary working group to assist with this project. The project aims to fulfil recommendations from Outcomes Framework for the NHS ^[3], CNST ^[4] requirements and the RCOG ^[5] for the development of a standardised review and reporting mechanism with performance management tool to allow acute services and their commissioners to respond efficiently and effectively to adverse outcomes.

Objectives

1. To provide a tool for standardised review of perinatal deaths
2. To ascertain learning points and resultant actions to improve clinical practice
3. To respond appropriately, ensuring that the such action points are implemented in timely manner

Method

The process is supported by an electronic tool, which combines aspects of the confidential enquiry proformas developed by the Perinatal Institute, and the principles of the taxonomy developed by NPSA. SCOR (Standardised Clinical Outcome Review) assists in-house teams with a methodological review of all relevant circumstances surrounding a stillbirth or neonatal death.

The SCOR application incorporates the Perinatal Death Notification (PDN) as well as sections on each aspect of perinatal care (e.g. antenatal, intrapartum, postnatal). It is designed for completion by the clinical governance lead, on behalf of the whole in-house perinatal mortality review team, who agree the standard of care and overall avoidability grade. A case summary is generated on completion of SCOR which includes Risk Factors, Key Points and Taxonomy (care issues). An Action Plan is also incorporated, to support Trusts’ progress in addressing the identified care issues.

Peer Review Panel (PRP) is the main quality assurance part of SCOR; a key aspect of the review process to support robust and standardised assessment of cases across units.

Pilots

Following regional consultative and training meetings, 6 West Midlands Trusts in September 2011 started to pilot the SCOR application. Since then 12 other units have requested to join the pilot across England and Scotland, including one in Canada.

Total Number of Cases Entered onto SCOR

Since the pilot commenced at the end of September 2011 and the end of November 2012, a total of 375 cases have been inputted.

For copies of the SCOR Pilot Update letters please click here.

For more information about SCOR or to discuss how SCOR could support the perinatal death review process in your hospital, please contact Fiona Cross-Sudworth, Project Manager or Professor Jason Gardosi, Project Lead.

Email: fiona.cross-sudworth@pi.nhs.uk; jason.gardosi@pi.nhs.uk

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