Hospital Deaths

Hospital bereavement services that are led by senior doctors and nurses and the person responsible for quality and safety may help to curb patient complaints and legal action in the wake of a difficult death, suggest the results of a pilot study, carried out at one NHS hospital trust and published online in the journal BMJ Supportive & Palliative Care.

Families who use hospital bereavement services often do so because they have unanswered questions; hence about the diagnosis or issues around the quality of the care provided; hen say the study authors. Complaints and legal action are both more likely when relatives feel their questions have not answer satisfactorily and/or steps not taken to stave off the likelihood of a repeat of similar circumstances, they add.

Quality and safety lower risk

The authors want to find out if a hospital bereavement service; which led by senior clinicians and the quality and safety lead might lower the risk of complaints, coroners’ inquests, and legal proceedings; hence as well as help relatives cope better with a difficult death. The use the Medway Model under which relatives are contact the next working day after their love one’s death; hence also invite to a 1 hour semi structure meeting at the hospital with the relevant specialist doctor and the matron on whose ward the patient died.
Meetings are held sooner if the death is the subject of an inquest, to reduce the coroner’s workload and better prepare families. At the meeting, relatives are encourage to describe their version of events, and to expect to get answers to their specific issues and concerns. Formal minutes are take by the hospital’s surgical lead for quality and safety, and actions agreed.
Within a week of the meeting, type minutes are sent to the relatives, who are inform of the results of any further investigations or outstanding issues. And their anonymised feedback (good and bad) is relay to all those involve in the patient’s care. The service apply only to deaths following surgical procedures between May 2017 and January 2018; so during which time 121 invitations were sent out, and 18 families (just under 15%) took up the offer.

Nursing care, communication

Most (83%) of these families had unanswered questions about the clinical care given to their relative; so while more than three out of four (78%) had questions about the quality of care provide. Around one in 10 (12%) had questions about both. The most common clinical themes related to the management or treatment of their loved one; so the timing of investigations, and whether anything could have saved his/her life.
The most common issues of concern were about the quality of nursing care, communication with and between various health professionals; so the need for reassurances that other patients wouldn’t have to experience what they had been through. Analysis of the feedback forms show that nearly half of respondents (44%); which would have made a formal complaint had they not been able to get answers to their questions. Two families had already sought legal advice, but neither went ahead after the meeting.
Most of those who use the service said they had obtain closure; with the remainder awaiting further information which wasn’t available at the meeting. An add bonus was the ability to involve families in investigations into serious incidents. Many other models appear to provide counselling or other psychological support; so rather than specifically aim to reduce complaints, inquests and litigation through providing answers to questions or direct discussion; so about issues of governance, write the researchers.
It is our view that families should not have to litigate or complain to get answers or raise concerns following the death of a love one. They should have a right to access this through the hospital services, they add. This pilot study is base on surgical cases alone at one hospital trust, and so may not be applicable elsewhere, but it may be worth exploring further, say the authors.