Audit of deaths in general practice: pilot study of the critical incident technique.

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Abstract
OBJECTIVE--To develop and pilot a method for conducting an audit of deaths in general practice by the critical incident technique. DESIGN--Prospective use of the technique within a primary health care team, with the aid of a facilitator, to analyse the events surrounding patients' deaths. SETTING--One inner city academic general practice. PARTICIPANTS--Practice team, comprising general practitioners, trainee, practice manager, practice nurse, and attached health visitor and district nurses. MAIN MEASURES--Identification and classification of critical incidents associated with the case studies of eight recently decreased patients in the practice and subsequent impact on the practice. RESULTS--Among the eight case studies, 57 critical incidents were identified (mean 7.1 per case, range 2 to 15). A failure of communication was the most common factor identified in incidents giving rise to concern, but positive factors in patient care were also identified. Changes in practice included developing protocols for follow up of bereaved relatives and carers and a checklist to ensure completion of administrative follow up tasks resulting from the patient's death; cases of recent deaths and terminally ill patients were reviewed monthly. The practice team found the method acceptable and felt that the discussions had provided useful opportunities for reflecting on their role in patient care. CONCLUSIONS--The critical incident technique fulfils the needs of an audit of deaths in general practice; however, further evaluation based on more cases from different practices is now required.