NCMD has received a number of queries from CDR professionals asking for help with running CDRMs. Here we provide guidance on what to think about before, during and after the meeting as well as how to get the most out of the discussion.
- DO decide at the outset who is essential to the discussion (i.e. who you can’t hold the meeting without). This might be the cardiologist if the child had a complex heart problem, or the GP if the child attended their Practice shortly before death. It is unlikely that you will be able to get every single person to attend but if you have the key agencies represented, the discussion will be a lot more fruitful.
- DO make sure you have a copy of the Reporting Form and/or other information provided by professionals to their local CDOP (the CDOP office should be able to provide you with this). This is especially important where people are unable to attend the meeting. It will give you their perspective which can act as a substitute in their absence.
- DO give people at least one month’s notice of the date if you can so they can arrange cover for clinics etc. It is more important to have as many of the essential people present for the discussion than to hold the meeting within a certain time frame.
- DO try to accommodate attendance by telephone / video call where possible.
- DO make sure everyone understands the purpose of the meeting at the outset. The Chair should explain this.
- DO make sure that everyone understands the confidential nature of the meeting.
- DON’T assume that everyone has been to a CDRM before, or that they understand how the meeting works. Ensure that you undertake introductions at each meeting before you explain the purpose.
- DON’T hold the meeting until you have a copy of the post-mortem report.
Before the meeting
Where will the meeting be held?
Hospital deaths: The Child Death Review Statutory and Operational Guidance 2018 is clear that the CDRM should usually happen at the hospital of death. This is the case regardless of whether it is the CDOP of residence or the CDOP of death who will review the case. Most hospitals will already have established mortality review processes for children who die within their Trust. The CDRM should not be held as an extra meeting, but instead the existing mortality review meeting should be used to complete the draft analysis form.
Deaths outside of hospital: In cases where the child did not die in hospital, a location in the community can be used. There are CDOPs who hold these meetings at GP surgeries, hospices or community paediatric offices or at local authority or CCG premises. When choosing a location, consider how easy it will be for your essential attendees to get there. For example, holding it at a GP Practice will usually make it easier for the GP to attend as it is less time away from surgery, however it may be difficult for an oncologist from a tertiary hospital to travel to the GP surgery. Therefore, you may need to prioritise accommodating the needs of the professional who is most essential to the discussion. This will not be a problem if using video conferencing.
Who is responsible for arranging it?
This will vary from area to area depending on your local arrangements. However, for deaths in hospital that will be reviewed via hospital mortality processes, these will be arranged by the hospital in the normal way.
For CDRMs happening outside of the hospital, the CDOP administrator, JAR professionals or Designated Doctor may have a role in arranging it depending on local arrangements.
Sections 4.3 and 4.4 of the Child Death Review Statutory and Operational Guidance covers who should be invited to attend the meeting and who should chair it.
Where possible, an administrator should attend to take notes of the meeting as it will be difficult for the Chair to do both.
During the meeting
It is useful to have a brief agenda to follow during the meeting, for example:
- Welcome and introductions (Chair)
- Confidentiality statement (Chair)
- Purpose of the meeting (Chair)
- Discussion of the circumstances of the death
- Discussion of family questions / comments
- Completion of draft analysis form
- Ongoing support and feedback to the family.
It is useful to invite everyone to talk about the interaction their agency had with the child during life. This can be done chronologically based on the order that agencies interacted with the child e.g. if they had a routine GP appointment a couple of days before death, the GP could contribute first, followed by the ambulance service (if there was then an acute collapse), the emergency department staff, other hospital staff and then JAR professionals. If the child was not previously known to any services, then it is likely the meeting will be small, and the JAR professionals can lead this part of the discussion.
Ensuring the family’s perspective is included
The parents should be made aware that the CDRM is happening. It should be explained that this is a meeting for professionals, and they should be supported to provide any questions or comments that they would like discussed at the meeting. The key worker may take on this role, or it may be more appropriate for someone else to facilitate this if they have a trusted relationship with the family. It is important to consider what additional support families might need to give their views, particularly if they have additional needs. It is also important to remember that, when this conversation happens, it may be some time after the death has occurred and the family might not be expecting to be asked about their thoughts and whether they have any questions so far after the event. This may be hard for them to think about and should be handled sensitively and compassionately.
Some families will not want to contribute at all, and some will have detailed questions and comments that must be addressed at the CDRM. The family should be given at least a week to think about and compile any questions and comments that they would like answered.
At the meeting, a decision also should be made about who should provide feedback to the family after the meeting. The family should receive feedback as soon as reasonably possible after the CDRM has occurred. This should include ensuring that the right people are available to answer their questions. It might be that the group feels that more than one professional should provide the feedback. If this is the case then, wherever possible, the feedback should be given at a joint meeting to ensure the family does not have to attend multiple meetings.
Completing the analysis form
The analysis form can be populated either at the meeting itself or following the meeting if this is easier. Most of what needs to be recorded in the draft analysis form will be raised as part of the discussion without your intervention. However, it is useful to look through each of the sections of the form as the discussion progresses to check whether there is anything else that needs to be discussed. Those present at the meeting should agree the categorisation of death and whether they think any modifiable factors have been identified. For more information on how to complete an effective analysis form, CDR professionals can request the recording of NCMD’s webinar on this topic by emailing NCMD.
After the meeting
The draft analysis form should be circulated to members of the meeting for comment. Any comments received can then be included in the draft as appropriate prior to sending it to the CDOP office who should, in turn, update NCMD.
- For a personal perspective on the value of child death review (CDR) meetings from NCMD’s Manager, Vicky Sleap, read her blog: Learning from Loss: The Value of Child Death Review Meetings.
- Go to the NCMD website for further resources for professionals.