Background Our professional responsibility towards a patient continues after they die (General Medical Council. Treatment and care towards the end of life: good practice in decision making [internet]; 2022). National guidance stipulates that ‘deaths are required by law to be registered within 5 days’ (Office for National Statistics & HM Passport Office. Guidance for doctors completing medical certificates of cause of death in England and Wales [internet]; 2022). Among the English regions, the percentage of deaths registered within one week is lowest in the East and South East (Office for National Statistics. Impact of registration delays on mortality statistics in England and Wales: 2021 [internet]; 2023). A major contributor to delay is thought to be the interval between verification and certification of death (National Association of Funeral Directors. Picking up the pieces [internet]; 2023).

Aims

1. To audit the median time between verification and certification of death.

2. To identify contributory factors to this time interval.

3. To reduce the median time by 1 day.

Methods A team comprising a junior doctor, Lead Medical Examiner and Medical Examiner Officers audited the median time between verification and certification of deaths at an acute hospital in the East of England from November 2022 to May 2024. Junior doctors were surveyed on factors contributing to delays in certification and changes were implemented accordingly.

Results Median days to death certification reduced from 2 to 1; percentage certified within 5 days rose from 96% to 100%. Relocating the Bereavement Office to a more central location heightened accessibility. Junior doctors reported that lack of familiarity with or lack of opportunity to discuss the deceased’s case with a responsible Consultant still contributed to delays in certification. Stakeholders welcomed the concept of recording an ‘anticipated’ cause of death prior to the end of life as a way of addressing this issue.

Conclusion We have demonstrated that junior doctors have a key role to play in identifying problems and initiating creative solutions toward streamlining the death certification process. Recording an ‘anticipated’ cause of death—which is unlikely to change after death—at the time of commencing end-of-life care is a novel means of supporting the doctor who eventually certifies the death and could, in turn, expedite the registration process.