Audit to evaluate delays in filling out Medical certificates of cause of death

Introduction

A doctor's duty of care continues after a patient's death until the body leaves the hospital. Following a patient's death, doctors involved in their care receive reminder emails until a proposed Medical Certificate of Cause of Death (MCCD) is submitted. The case is then reviewed by a Medical Examiner (ME), who determines whether the cause of death is acceptable, requires amendment, or should be referred to the Coroner. Delays in completing this process can cause significant distress to bereaved families by delaying funeral arrangements and final rites.

Method

The Bereavement Team at Medway Maritime Hospital maintains a database of inpatient deaths, including dates of reminder emails, proposed cause of death, Coroner referrals and final MCCD completion. We analysed the number of working days between the date of death and proposed MCCD, ME acceptance and final MCCD completion, Coroner referral, and CN1A to final MCCD. Cases requiring an inquest or post-mortem were excluded due to unavailable data. Following the first audit cycle, an electronic MCCD system was introduced, allowing approved proposed MCCDs to populate the final certificate. Teaching sessions and awareness posters were also implemented between audit cycles.

Results

Across all specialties, implementation of the electronic MCCD system and targeted educational interventions was associated with improved timeliness of death certification. A greater proportion of proposed and final MCCDs were completed within 0–1 working days, with corresponding reductions in delays of 2–4 and 5–7 working days. Timeliness of Coroner referrals also improved across the trust, with referrals completed within 0–1 working days increasing from 51.7% to 73.0%, while referrals taking 5–7 working days reduced from 13.3% to 4.8%. Analysis then focused on patients under Frailty, where completion of proposed MCCDs within 0–1 working days improved from 58.3% to 76.9%, while completion of final MCCDs within 0–1 working days following Medical Examiner approval increased from 70.8% to 91.7%. Delays exceeding four working days were eliminated in the second audit cycle.

Conclusion

Introduction of an electronic MCCD system, supported by targeted education and awareness initiatives, was associated with improved timeliness of MCCD completion and Coroner referrals. Streamlining the certification process can minimise avoidable delays, reduce distress for bereaved families, and facilitate timely funeral arrangements.