I wanted to touch on a subject that is important but often not laid out in a concise manner - the protocol after a patient expires.
I want to break this down into responsibilities of each of the staff. For residents (like myself) this often seems like a seamless process that happens in the background, but the reality is, multiple members of the ED are all coordinating together to progress this process.
Physicians-
1. Attending physician must pronounce dead.
2. Admitting must be called with time of death, cause of death, whether or not the medical examiner will accept the case (more on that in a bit). Admitting will then process this info, and upload info to NYC Certify. The attending will then have to go into NYC Certify and certify the death.
3. The patient's family must be notified. Hopefully they are in the hospital, as it is more appropriate to have this conversation with the patient's family face to face, in private and to give them time to grieve with the patient.
4. Medical examiner must be notified in certain instances. The ME will take the following types of cases - trauma arrests, homicides, suicides, younger patients that are not terminally ill. Typically the ME will not take older patients with comorbidities. When in doubt, call the ME and they can decide.
5. Finally, the death note needs to be completed.
Nursing-
1. Charge nurse will call the expeditor / patient rep (more on that in a bit).
2. NYC LiveOn. This is the organ donor group. In our ED, nursing typically calls them. This requires answering questions about time of death, cause of death, medical comorbidities.
3. Nursing and PCTs are typically responsible for post mortem care in patients that are not Jewish (more on the Guardians of the Sick in a bit). This involves removing lines, ET tubes, cleaning the patient, etc. This is NOT to be done in ME cases.
4. There is a written nursing protocol, on the MMC intranet site, I have shared the link below.
Expeditor/Patient Rep-
1. If the patient is Jewish, the expeditor will contact the operator, who contacts the Guardians of the Sick, who come and do post mortem care.
2. The patient rep may go to the family and offer support and comfort. Cannot provide suggestions regarding funeral homes (this is a conflict of interest).
3. Contact transport if the patient is going to our morgue (sometimes the family will arrange for the patient to be transported to a funeral home instead).
Hope this helps outline the process and responsibilities during these stressful situations!
http://intranet.mmc/Main/DocumentLibrary/Post_Mortem_Care_2762.aspx