When a patient dies unexpectedly in a hospital setting, communication among next of kin, medical examiners, hospital staff members and other clinicians often is challenging. The information needs of these diverse interests vary, with the medical examiner seeking to determine the cause and manner of death in the interest of advancing criminal or civil justice and for public health purposes; the hospital and its medical professionals wanting to better understand the death of the patient for quality assurance purposes and to advance the science of medicine; and the patient's next of kin desiring answers as to how and why their loved one died.
Now, the AMA has developed new guidelines aimed at improving communication during these situations.
Developed in consultation with the AMA Postmortem Communication Workgroup, "AMA Guidelines for Communication Between Hospitals, Medical Examiners, and Next of Kin Following Unexplained or Unexpected Deaths in the Hospital,(www.ama-assn.org)" was released earlier this fall. Julie Wood, M.D., the AAFP's vice president for health of the public and interprofessional activities, served as the only nonpathologist in the workgroup.
- When a patient dies unexpectedly in a hospital setting, communication among next of kin, medical examiners and hospital staff often poses challenges.
- An AMA workgroup that included a family physician has developed new guidelines aimed at improving communication during these situations.
- Specifically, the guidelines call for hospitals to create a single point of contact to coordinate communication among hospital staff, medical examiners and next of kin.
"I am pleased the AMA recognized the value of having a family physician participate in the workgroup and on the development of the guidelines," Wood said. "The guidelines will be helpful for family physicians to optimally provide comprehensive care and communication in the event of an unexplained or unexpected death.
"Although we don't deal with this every day, when it comes up, we often don't get information back regarding an outcome," Wood explained. Among the guidelines' recommendations is that autopsy results be shared with the physicians of the deceased patient, which Wood said would allow family physicians to better communicate with the patient's family and attend to their needs, both medically and psychosocially.
Specifically, the guidelines call for hospitals to create a single point of contact to coordinate communication among hospital staff, medical examiners and next of kin. Medical examiners should follow suit by creating their own single points of contact.
According to the guidelines, it's important for medical examiners to notify the hospital if they'll accept or decline a case referred to them for review within a reasonable amount of time. When a medical examiner does assume jurisdiction over the case, the following information should be shared by the various stakeholders.
- Medical examiners should communicate information about the investigation process to the patient's next of kin, including an estimated timeline. The AMA guidelines further support related recommendations from the Scientific Working Group for Medicolegal Death Investigation(www.swgmdi.org), a collaboration of diverse forensic experts jointly sponsored by the National Institute of Justice and the FBI.
- Hospital staff, including attending physicians, should participate expeditiously in the investigation process by fulfilling related requests and making themselves available for consultation.
- Whenever possible, preliminary autopsy findings should be shared with next of kin and the referring hospital, and final autopsy results should be shared with those who have requested it. Medical examiners should participate in a post-autopsy conference with the next of kin and others chosen by the next of kin, such as physicians who cared for the deceased.
The guidelines also recommend that hospitals seek permission to conduct their own autopsies either subsequent to a medical examiner autopsy or when the medical examiner declines jurisdiction of the case. These autopsies can identify hereditary illness, help guide hospital quality assurance strategies, and contribute to medical education and research. When hospital autopsies are authorized by next of kin, they should be held to the same communication standards recommended for medical examiners.
The Postmortem Communication Workgroup readily admits the guidelines are idealistic, but contends that they can function as a starting point for improving communication. Variations in state laws and hospital system practices and understaffed medical examiner offices can make adherence to the guidelines a challenge, Wood said. However, "It's important for family physicians to be aware that this model guideline exists, and that they can be a part of implementing it."