48 Managing sudden deaths in hospital

Abstract

Introduction Sudden and unexpected, in-hospital deaths are a common occurrence. Currently, there are no national guidelines to assist staff with the management of these events and, providing optimal end-of-life-care in these circumstances is challenging. We designed a questionnaire to explore the experiences of relatives who had been bereaved in this way. Methods Over 17 weeks, a questionnaire was offered to recently, bereaved relatives who attended the Bereavement office at the University Hospital of Wales. The questionnaire explored how, who, where and when the death was disclosed; whether sufficient privacy was afforded, full explanation offered, time for questions allowed, and whether the communication was empathetic and caring. Other questions asked if relatives had been allowed to view the deceased, whether religious and cultural observances had been facilitated, tissue donation discussed, and explanation for coronial referral offered. Results Questionnaire response rate: 69/487=14%. Sudden, unexpected deaths: 33/69=48%. Sudden deaths communicated in face-to-face meetings: 28/33=85%. By telephone: 5/33=15%. Location of disclosure: at bedside 22/28=79%, private room 6/28=21%. Communication by: consultant 18/33=55%; nurses 8/33=24%; trainee doctor 1/33=3%; others 6/33=18%. Communication empathetic and caring 33/33=100%. Time of disclosure: immediately on arrival 17/33=52%; within 30 minutes 7/33=21%; within 1 hour 2/33=6%; within 1–2 hours 2/33=6%; > 2 hours after arrival 2/33=6% and present at `death 3/33=9%. Full explanation of the cause of death offered 32/33=97%. Sufficient time for questions 32/33=97%. Allowed to view deceased: 32/33=97%. Explanation for referral to Coroner: 14/21=67%. Religious and cultural observances facilitated: 16/33=48%. Organ and tissue donation discussed 7/33=21%. Conclusion In general, the process of disclosing unexpected hospital deaths to relatives is done well. Improvements could be made by expediting family meetings, prioritising privacy, discussing tissue donation and facilitating religious and cultural observances. A national guideline would be useful.