Background St Oswald’s Hospice strives to ensure high standards of communication and documentation after death, in line with Hospice UK’s Care after Death guidance, to support bereaved relatives, meet legal requirements and for coronial processes. From April 2023 it will be statutory law that all non-coronial deaths must be reviewed by a medical examiner (ME). The ME role was integrated into our practice from September 2022. This audit aimed to assess our communication and documentation prior to ME introduction and as the role was established.

Methods 100 patients who died in the inpatient unit prior to ME and 19 patients after initial introduction of ME role had documentation reviewed with a standard of 100% in recording:

• Cause of death as stated on the Medical Certificate of Cause of Death (MCCD) and discussion with family

• Whether the patient was for burial or cremation

• External health professionals notified of the death

• Details of any discussion with the Coroner’s office or ME and subsequent explanation to the family

Results (Pre ME and post ME/amending documentation):

o Cause of death as stated on the MCCD was recorded in medical notes in 97% and 100% respectively.

o Burial or cremation was documented in 84% and 89%.

o 100% of GPs were notified of patients’ deaths.

o Prior to ME 25% of deaths were discussed with Coroner of which 40% had details documented. Post ME 37% of deaths were discussed with Coroner and 63% with ME, 53% of those had details of discussion with family documented overall.

o Documentation of discussions with family regarding content of MCCD was present in 15% and 53% respectively.

Conclusion Introduction of ME and amending documentation templates following initial audit has led to an improvement in communication and documentation after death. Further improvement and re-audit continues.