3D's of death documentation: Improving mortality documentation at King’s College Hospital (KCH).

Introduction  

Accurate mortality documentation is essential for safe communication with primary care and learning from deaths. At KCH, inconsistent death documentation following inpatient deaths on Gerontology wards was identified with incorrect information being communicated to GPs indicating the patients were still alive. 

Aim  

To identify barriers within the electronic documentation pathway and increase the proportion of correctly completed discharge summaries following inpatient deaths.  

Methods  

Using the Plan- Do-Study- Act methodology, we reviewed 206 deaths from September 2025 to May 2026.  Our stakeholders included doctors at all levels of training, nurses and medical examiners. After discussions, we identified three key steps to death documentation which include: clinically verifying death, marking the patient as 'discharge as deceased' on Epic (electronic medical records system) and completing a discharge summary. Key interventions included showcasing the mortality database at monthly mortality meetings, brief teaching sessions done at induction for new doctors and monthly consultant reminders about incomplete discharge summaries.  

Results  

Baseline data suggested that between September to December 2025, the proportion of discharge summaries correctly completed was 45% (40/ 94), incorrectly completed was 10% (10/ 94) reflecting that the patient were still alive, and not completed was 45% (44/94). We identified that nurses were not involved in death documentation and there was a limited knowledge among doctors about accurate death documentation on Epic.  Following interventions, the proportion of correctly completed discharge summaries increased to 90% in May 2026 (21/23). 

Conclusion  

A structured QI approach incorporating education, stakeholder engagement and feedback led to marked improvement in mortality documentation. We look forward to disseminating this project to the wider King's network and collaborating with the medical examiners’ office.