Background In response to several public inquiries, the Government reformed the process of death certification in England and Wales. Medical examiners (ME) have been recruited in hospitals to conduct independent medical scrutiny of cause of death and engage with bereaved families to understand their concerns. The ME initially contacted the hospice to expand the service to hospice deaths in the area.

Method From initial multi-professional discussions, a pilot programme was developed to refer all hospice inpatient deaths to the local medical examiner office (MEO). Information governance and IT support allowed note sharing between the hospital and hospice via electronic patient records, a referral algorithm was developed, and the pilot was started. Throughout the process there were multiple ongoing virtual meetings, to ensure continual improvement. These improvements included ensuring deaths could be registered within 5 days and streamlining discussions with the coroner.

Results Number of referrals 1/2/2021 - 8/12/21

Total deaths Coroner referral 100A/NFA 100B Inquest

177 27 23 1 3

The pilot programme went well. The MEO has been able to support when cause of death or need for coroner referral has been uncertain, the accuracy and consistency in recording cause of death has improved (e.g. ‘squamous cell lung cancer’ rather than just ‘lung cancer’), and importantly, it has successfully provided a separate support service for the bereaved to help navigate the process and give feedback about care provided.

Conclusion This has been a successful pilot programme, remarkable given the hospice is not on the site of the hospital. The ME process is now integrated into the hospice care after death procedures.

The ME is using this positive experience in the roll-out of scrutiny to all community deaths in 2022. We hope our experience can help provide insight for other hospices as they start working with their local MEO.