Improving documentation, communication and efficiencies of administrative processes after a patient death on an acute hospital

Introduction:

Timely completion of the Medical Certificate of Cause of Death (MCCD) is essential for legal reasons, to support grieving families, and to allow funeral arrangements to be made. On the acute geriatric ward, delays in tasks related to patient death and poor documentation were observed. It was hypothesised this was related to unclear responsibilities, lack of continuity in following up Procurator Fiscal (PF) referrals, and variable confidence in certifying death.

Method:
This quality improvement (QI) project was conducted from November 2024 to April 2025. Baseline data identified key delays in MCCD completion and PF referral documentation. The following interventions were introduced: a dedicated board to record patient deaths and outstanding tasks, a step-by-step post-death process guide placed in the acute clinical area, and prompts added to the daily multidisciplinary team huddles to enquire about patient deaths and outstanding tasks. Weekly data collection tracked changes in documentation and timeliness.

Results:
Baseline data (n=21 cases) showed that only 33% of MCCDs were completed within 24 hours. PF referral documentation was absent in all cases, though all outcomes were recorded. The longest delays to MCCD completion were 85 hours (non-PF) and 286 hours (PF), highlighting a gap in referral tracking and visibility of tasks.

Following the intervention, 85% of MCCDs were completed within 24 hours, and the average time from death to MCCDs completion was 12 hours. This showed a clear improvement in the timely completion of important tasks.

Conclusion:
A visual guide and structured verbal reminders led to significant improvement in the post death process. This simple intervention has already been implemented in other wards to improve post-death care and reduce distress for bereaved families.