Case study: Northern Lincolnshire and Goole NHS Foundation Trust


Northern Lincolnshire and Goole (NLAG) NHS Foundation Trust provides acute hospital services and community services to a population of more than 350,000 people across North and North East Lincolnshire and East Riding of Yorkshire. NLAG had previously been placed in the worst fourteen performing trusts in the country based on its mortality indices. Thus, in the last few years there has been an increased focus on mortality reviews to help the Trust understand the local context and help identify and develop improvement of care processes.

Review process

NLAG joined the Improvement Academy’s Mortality Review Programme in 2014 and the Structured Judgement Review methodology for case notes reviews was adopted. A random case selection for in-depth reviews is done for the 6 categories of highest crude mortality in the trust:

  • Respiratory
  • Cardiology
  • Cerebrovascular Accident
  • Gastroenterology
  • Sepsis
  • Cancer (now termed end of life)

Mortality and morbidity meetings have been set up for each category. The reviews are discussed at these meetings and improvement plans are put in place if any failing in care is identified.

Examples of themes and quality improvement initiatives

End of life care has been identified as a cross cutting theme in all the above categories. NLAG has developed a multi-agency approach to end of life, recognising that hospitals are only a touch point in a patient journey. This has led to better collaborative working with Clinical Commissioning Groups and GPs, allowing the trust to do end to end reviews and look at factors influencing admissions (including social care).

Other improvement initiatives following case notes reviews include:

  • Oxygen prescribing on charts
  • Outreach team set up for respiratory patients
  • Improved stroke pathways
  • Engagement with alcohol services and improved linkage between community and secondary care
  • Review of bed allocation
  • New pathway for heart failure
  • Working with the ambulance service to improve early management of sepsis

The future

Improved case selection and thematic analysis.
Improved screening process for patients with learning disabilities and dementia.
Further expansion of the review process to other speciality areas outside of the ‘top 6’ identified areas.
Expansion of Trust’s internal training of reviewers to support embedding of this methodology in the organisation. This would further enable effective identification of improvement areas and sharing of learning.

If you would like an update on the progress of the above trust with regards to mortality reviews and quality improvement initiatives, please contact