Course Summary

Structured Judgement Reviews under PSIRF

Course Description 

Structured Judgement Reviews (SJR) are often used as part of clinical governance processes in an organisation to review the care received by patients who have died.  The judgements made under the review process will often feed into other investigation types or contribute to the development of quality improvement initiatives. 

With the new Patient Safety Incident Response Framework SJRs can be used to determine if there are any learning opportunities that require further exploration and/or action. 

This will mean the focus of SJRs should move away from questions of avoidability of harm and instead be looking at whether an incident should be considered for a Patient Safety Incident Investigation or whether learning from it can contribute to a thematic review or other quality improvement work an organisation is undertaking as part of their Patient Safety Incident Response Plan. 

Course Content

  • Where SJRs fit in the overall clinical governance structure of their organisation, why they are being conducted and what questions they are designed to answer
  • How to organise case notes for effective review; use of timelines
  • What other sources of evidence to consider
  • Making explicit judgements around quality of care; evidence base and standards used
  • When and how to escalate potential issues with professional conduct
  • Duty of Candour considerations


09.00am to 09.15am  Logon, timings and housekeeping
09.15am to 09.30am  Introductions
09.30am to 10.00amBackground and context
10.00am to 10.15amChanges under PSIRF 
10.15am to 10.30amEstablishing the questions you are answering/judgements you are making – case study
10.30am to 10.45amCoffee Break
10.45am to 11.30amEvidence collection and organisation; use of timelines
11.30am to 12.00pm  Exercise
12.00pm to 12.15pm  Feedback on group work 
12.15pm to 1.15pmLunch
1.15pm to 2.00pmConsiderations for analysis of each stage of the 6 stages of care
2.00pm to 2.30pm What standards to use; what is a problem? Exercise. 
2.30pm to 2.45pmTea Break
2.45pm to 3.00pmThe importance of precision writing; evidence base and rationale. Exercise. 
3.00pm to 3.45pmLearning and potential for systemic change
3.45pm to 4.00pmConclusion

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