‘Til Death Do Us Part.

Clinical education focuses on the optimization of diagnosis, treatment, disease prevention, and quality of life for the patient. Establishment and maintenance of the physician-patient relationship is also an integral part of the clinical learning experience. Despite the best of all efforts, there are limitations in medical interventions aimed at saving lives and ultimately, the physician-patient relationship must dissolve.

The clinical care team must complete a number of complex tasks for the infrequent occurrence of an impending or unexpected, traumatic or natural hospital death in accordance with established hospital policy 1. These include clinical procedures with adherence to any advanced care directives, pronouncement of death, notifying family, providing family with the means for bereavement, notifying the organ/tissue procurement organization, providing education and obtaining consent from the family regarding a hospital autopsy where applicable, and fulfillment of legal requirements in homicidal deaths. Homicidal deaths will require notification of law enforcement, reporting the death to the Medical Examiner/Coroner (ME/C), and securing any evidence inclusive of the deceased’s body 2. While some variability exists, state law mandates the reporting of deaths that are sudden, unexpected or unnatural to the ME/C.

Fundamentally, clinicians must know not only when and how to report a death, but why. Understanding the “why” facilitates the whole process of reporting. The insufficiency of consistent, periodic education on this topic has fueled uncertainty, lack of knowledge, and lack of understanding 2 regarding:

  • state laws that mandate reporting and by whom 2,3
  • specific types of reportable deaths 2,3
  • specifics on how to report a death 2
  • the public health importance of reporting deaths 2
  • physician responsibilities for in-home patient deaths 4
  • the requirements and the role of the ME/C 2,3

Consistent and periodic education with assessment is necessary, as early as third or fourth year of medical school or at least starting early in the first year of residency. Various learning platforms such as textbook-based lectures, morbidity mortality review conferences, and online courses and tutorials can be utilized to ensure reinforcement and retention of knowledge throughout the years of clinical training and provide continuing medical education following training.

 

References:

  1. O’Malley P, Barata I, Snow S, et. al. Death of a child in the emergency department. Pediatrics. 2014;134:e313-e330.
  2. Armstrong EJ. Essentials of Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner. 2017. Available at: https://www.amazon.com/Essentials-Death-Reporting-Certification-Applications/dp/0998533408 .
  3. Charles A, Cross W, Griffiths D. What do clinicians understand about deaths reportable to the coroner? J Forensic Leg Med. 2017;51:76-80.
  4. Yang M, McNabney MK. Physicians’ responsibilities for deaths occurring at home. J Am Geriatr Soc. 2017;65(3):648-652.

 

Stay tuned for more Practice Pearls!

 

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