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All forms of criminal violence or from an unlawful act or criminal neglect

All accidents (motor vehicle, industrial, home, public place, etc.)

All suicides

All deaths that are caused or contributed to by drug and/or chemical overdose or poisoning

Sudden death of a person in apparent good health (without significant past medical history associated with sudden death, such as coronary artery disease, etc.)

Deaths of all persons in legal detention, jails or police custody. This category also includes any prisoner who is a patient in a hospital, regardless of the duration of hospital confinement.

Deaths which occur during diagnostic or therapeutic procedures or from complications of such procedures

Deaths due to disease, injury or toxic agent resulting from employment

Deaths which occur in any suspicious or unusual manner.

See This Memo From the OCME

http://www.nyc.gov/html/doh/html/data/chi31-6_index.html

Improving Cause of Death Reporting: Update 2012
Accurate and detailed cause of death reporting is critical for disease surveillance, public health research, and forensic investigations.
Cause of death reporting requires:
Review of the medical record
Identification of all conditions and events leading or contributing to the death
Ordering the conditions and events in a medically probable sequence

Death certificates are both important legal documents and essential public health tools. Rapid reporting enables families to arrange funerals and settle estates quickly and helps government agencies prevent the fraudulent use of birth certificates, driver’s licenses, Social Security benefits, and other entitlements. Timely and detailed documentation of cause of death (and other significant conditions and events related to that cause) is crucial to public health reporting and surveillance. The New York City (NYC) Health Department and the Centers for Disease Control and Prevention (CDC) rely on cause of death data to identify outbreaks and emergencies, such as pandemic flu and heat waves. For these reasons, the NYC Health Code requires that all deaths be reported within 72 hours.
The NYC Health Department and other government agencies, as well as hospitals, researchers, and community-based organizations, use statistics from death certificates to identify public health priorities and develop appropriate interventions. Detailed cause of death reporting yields accurate information about neighborhood differences in the number of deaths due to diabetes, for example, enabling policymakers to target community interventions such as healthy food initiatives or physical activity programs. Incomplete or nonspecific reporting can lead to inaccurate statistics that can affect interventions, policy, and funding. Reporting cardiac arrest as the cause of death without recording the underlying condition (eg, metastatic breast cancer or chronic obstructive pulmonary disease) may cause an underestimation of mortality due to the true underlying illness (1-3). Chart review studies have identified substantial inaccuracies in cause of death reporting in NYC (4). Educating providers can improve the quality of death certificate information, making it a more useful tool for assessing population health (5).
Because the quality of cause of death data is critical for legal and public health purposes, each death undergoes multiple levels of review. Medical providers must understand how to document cause of death in sufficient detail to meet review requirements and avoid the need for resubmission. Electronic reporting in the NYC Electronic Vital Events Registration System (EVERS) has simplified the death certification process, but misconceptions still affect the quality and timeliness of reporting (Box 1).

BOX 1. MYTHS ABOUT CAUSE OF DEATH REPORTING
The “Burial Desk” at the NYC Health Department will not register the death if the cause provided is too complex.
Not true. Both the Burial Desk and the Office of the Chief Medical Examiner (OCME) prefer detailed and complete descriptions of the cause of death.
You must use a cause from the “list” of acceptable causes.
Not true. There is no list of acceptable causes of death. Use your clinical judgment and the patient’s medical history to detail causes of death.
Funeral directors have the authority to request a specific change to the Cause of Death section.
Not true. The funeral director is not authorized to tell the provider what to write as the cause of death, but may tell the hospital staff or health care provider to contact OCME or the Health Department about the cause of death.
Information from the death certificate doesn’t really matter anyway; it’s just to determine whether the death is a Medical Examiner case or not.
Not true. Death certificate information has many important public health and legal uses.
The certificate cannot be submitted if the cause of death fields in the Electronic Vital Events Registration System (EVERS) are yellow.
Not true. If you see an error message and yellow highlighted field, you must verify or update your entry and hit Validate. If the field remains yellow, but you feel the entry is complete and accurate, check the Override box, save the override, and submit the case. The data entry field will remain yellow after the override.

1. Consent the family, using this form.

2. Call the mortuary, extension 47376. If no one answers, leave a message.

Informing spouse of death:

http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_064.htm

Death notification over the phone:

http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_076.htm

http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_077.htm

Informing parents about infant/child death in ICU

http://www.eperc.mcw.edu/EPERC/WhatsNew/Articles/Informing-parents-about-actual

Ashley Shreves, MD

Includes issues that often come up around the medical examiner, sinai autopsies, and filling out the death certificate.

Autopsy and Death Certificate FAQ Lento 2007

Valued Mount Sinai Emergency Clinicians:

All patients who are pronounced in the ED must have an expiration chart filled out using the “ED MD Post-Mortem Navigator.” Expiration chart is the responsibility of the case attending, but may be delegated to other members of the clinical team. Note that the checklist may be filled out in pieces, so that, for example, when the next of kin is notified, that part can be entered, then later when the primary care physician is notified, that part can be entered.

If you forget to fill this out, don’t worry, you will be reminded by your friendly peer review team.

reuben

We’re not allowed to post screenshots of epic. To get to the post-mortem navigator from within a patient chart, use the “more activities” button on the bottom-left; this brings up a menu where you can select the post-mortem navigator. Under “expiration documentation” click “new reading.”

EMERGENCY DEPARTMENT POLICIES
SUBJECT:
Death Management Protocol
NO. 28
PAGE NO. 1 of 4

Original Date of Issue:  4/25/85

Current Revision:  4/03
Emergency Department staff are responsible for expeditiously coordinating the procedures following the death of a patient in the Emergency Department in accordance with hospital policy A3-115

PURPOSE:
Upon the death of a patient, all efforts must be made to assure for the proper care and disposition of the body and every reasonable effort must be made to inform the next of kin. In circumstances when there is no next of kin identified, attempts should be made to notify a significant other or emergency contact if no one has been identified. All such efforts must be appropriately documented in order to assure that all procedures have been properly adhered to. The individual accountabilities for the disposition of a deceased patient are outlined in this policy and include the roles and responsibilities of the physician who pronounced the patient, attending physician, Care Center Director, Clinical Nurse Manager/Nurse Administrator or designee, the Clinical Nurse, and the Business Associate (BA).

RESPONSIBILITIES:
PHYSICIAN
Notification Notification can occur via:
Direct contact with the next of kin and/or significant other/emergency contact if present at the time of death.
Telephone contact with the next of kin and/or significant other/emergency contact
Direct contact with the patient’s attending physician. Document in the medical record that the attending has agreed to notify the next of kin and/or significant other/emergency contact.

For patients admitted from an Extended Care Facility (i.e., Nursing Home, Subacute or Rehab facility), the Extended Care Facility must also be notified of the patient’s death.
If, after two (2) hours, attempts to notify the next of kin and/or significant other/emergency contact are not successful, or if the contact is still unknown, the physician must contact the Clinical Nurse Manager/Nursing Administrator or designee who will follow the procedures in policy A3-115
B.    Notifies NY Regional Transplant Program (1-800-GIFT-4-NY) NOTE: May be designated to the clinical nurse if appropriate.
C.     Obtains Post Mortem Consent
D.     When applicable, notifies  HYPERLINK “http://intranet1.mountsinai.org/risk_mgmt/admin/MEDICALEXAMINERREFERRALS.pdf” Medical Examiners Office at (212)-447-2030.  See ME guidelines attached.
E.     Completes Death Certificate and/or Medical Examiner Form

CLINICAL NURSE
Provides emotional support for next of kin and/or significant other/emergency contact. Assists  regarding procedures to be followed:  the body will be taken to the morgue and that they should notify a funeral director.
Notifies the Clinical Nurse Manager/Nurse Administrator or designee/Nurse Administrator and BA of the patient death.
Provide post mortem care (see procedure Post Mortem Care Nursing Procedure # 806)
Ensure that NY Regional Transplant Program has been contacted .(1-800-GIFT-4-NY).
Document in the medical record that all of the above has been accomplished.

BUSINESS ASSOCIATE (BA)
If trained, the BA may assist in the completion of death certificates and enters time of death into Cerner.
The BA notifies transportation (x44443) to transport body to the Morgue, except for direct removal (see Section V., Care of the Orthodox Jewish Patient).

Prepares the chart and forwards the chart, death certificate and related materials to Medical Records, B2 Level. On nights, the Assistant Administrator ensures that death certificates and charts are forwarded to Medical Records.
Signs the death certificate activity log. (Note: except with autopsy where the record accompanies the deceased to the morgue)
CLINICAL NURSE MANAGER/ASSISTANT ADMINISTRATOR
Coordinates the NY regional transplant process once they have been informed
Assists the clinical nurse and BA as needed
Assures that all records and forms are completed and received by medical records
Contacts the private attending or assigned attending pursuant to Section II, 1A and documents in decedent follow-up log the name of next of kin and/or significant other/emergency contact informed of the death, the time and the individual who notified the patient.
Initiates the protocol for unsuccessful notification of patient’s death as needed (see below).

UNSUCCESSFUL NOTIFICATION OF PATIENT’S DEATH PROTOCOL: Refer to Mount Sinai Policy A3-115

Medical Examiner Cases: Reportable Deaths
The Chief Medical Examiner (OCME) has jurisdiction over deaths occurring
under the following circumstances:
All forms of criminal violence or from an unlawful act or criminal neglect
**Applies whether the death occurs immediately and directly, or indirectly after a lapse of weeks, months, or even years**
All accidents (motor vehicle, industrial, home, public place, etc.)
All suicides
All deaths caused or contributed by drug and/or chemical overdose or poisoning
**Any infectious complication of intravenous drug use should also be referred to the OCME (i.e. AIDS, Hepatitis, endocarditis, etc)**
Sudden death of person in apparent good health
Deaths of all persons in legal detention, jail, or police custody
**This includes a prisoner who is a patient in the hospital, irrespective of the cause of death**
Deaths during diagnostic or therapeutic procedures or from complications of such procedures
Deaths of particular health significance (i.e. anthrax, smallpox, etc)
Deaths due to disease, injury, or toxic agent resulting from employment
When a fetus is born dead in the absence of a physician or midwife
Deaths unattended by a physician and where no physician can be found to certify the death
“Unattended” meaning not treated within 31 days prior to death
When there is intent to cremate the body or dispose of a body in any fashion other than internment in a cemetery
Dead bodies brought into the city without proper medical certification.
Deaths in any suspicious or unusual manner
There is no “24 hour rule” in NYC regarding deaths that need to be reported to the OCME. Rather, it is the circumstances surrounding the death that dictate whether the OCME needs to be notified.

NYC OCME Telephone #:   212-447-2030

Pastoral Services encourages you to call them for patients who may benefit from the services below.

The primary contact is Rabbi Goldstein, and you may call him 24/7 at 917.842.6091 for all faiths and needs – he will triage appropriately, perform phone consultations after hours, and even come in if he deems it necessary. A list of other pastoral care contacts (including priests for administering last rites) is below.

What is Pastoral Care?

Pastoral Care helps people of all faiths find:
meaning, healing, hope, and comfort while experiencing the challenges of life.
clarity for decision-making, inspiration, release from stress.
connection with their Higher Power, God, the Universe, the Creator, or that which is beyond us all.
balance and inner peace.

Professional Pastoral Care does not proselytize.

Pastoral Care:
allows people to draw upon and examine their own beliefs.
encourages people grow through their experiences.
meets patients where they are –- spiritually and emotionally.

Who can Benefit from Pastoral Care?

Patients, families, friends, staff – everyone!

When Should You Call Pastoral Care?

When individuals and families are:
experiencing conflict.
experiencing despair or losing track of hope.
confronting serious illness.
considering end of life issues.

Who Provides Pastoral Care?

Board Certified and experienced Chaplains.
Community faith leaders, such as pastors, rabbis, and priests.
Specially-trained volunteers.

Other Services

Sunday Mass, Sacraments, and Communion for Catholic patients & their families.
Kosher food for Jewish patients, daily and holiday services.
Major holiday services of various faith traditions.

How to Contact Pastoral Care

Department of Pastoral Care 212-241-7262
In-house extension 47262
Catholic Priests: 212-241-7908  Pager: 917-401-1680

More Contact information:

Rabbi H. Rafael Goldstein, Director
Department of Pastoral Care
212-241-7262
Cell Phone: 917-842-6091
Pager: Call the cell phone
Email: rafael.goldstein@mountsinai.org

Catholic Priests
Fr. Apolinari Ngirwa
Fr. Matthew Abba
212-241-7908
Pager: 917-401-1680
Email: apolinari.ngirwa@mountsinai.org
Email: matthew.abba@mountsinai.org

Pediatrics
Rabbi Mollie Cantor
212-241-6458
Pager: 917-537-0125
Email: mollie.cantor@mountsinai.org

Palliative Care
Rabbi Edith Meyerson
212-241-2234
Pager: 917-919-5902
Email: edith.meyerson@mssm.edu

Lots of confusion around death in the ED. Here are some frequently asked questions and answers.

1. What types of death should be accepted by the medical examiner?

a. suspicion of foul play (homicide, suicide, abuse, poisoning, etc.)
b. trauma
c. toxicology
d. unexpected/unexplained/unusual death or death of a child
e. complication of medical procedure (e.g. surgery, endoscopy)
f. possible public health threat (unusual infection)

2. If there is no concern for any of these issues, do I have to call the ME?

No.

3. If the ME accepts the case, what do I have to do?

a. document the ME case number.
b. that’s it. you do not have to fill out an electronic death certificate or do a death pack.

4. If the ME doesn’t accept the case, what do I have to do?

a. document who you spoke with.
b. fill out a death certificate online using DAVE. If you fill out an online death certificate, you do not have to fill out a death pack. If you don’t/can’t fill out an online death certificate, you have to complete a death pack. Instructions for using DAVE are here:

http://mssmem.com/?p=254

5. What if I’m concerned about one of the issues in Question #1 but the ME refuses the case?

It’s almost always not a physician but a medical investigator you speak with on the phone. Especially if you have concern for foul play, do not simply agree to call it complication of diabetes or whatever dubious cause they give you; remember that you are deciding what the cause of death is when you fill out a death certificate. Ask to speak with another medical investigator, the medical investigator’s supervisor, or the chief medical examiner.

If you have any concerns or questions about the death process contact Mount Sinai’s Queen of Death, Ms. Norfortiria Grant, of the medical records office at extension 49629.

Reminder: When there is a death in the ED between 8a-5p, call Medical Records and they can send someone to help enter info into the online death certificate system.  After hours, try to use the system (tutorial below) and call administrator on duty if you need help.

How to complete the death certificate online:
0. Use Reuben’s excellent offline PDF Tutorial or…
1. Go to “Start” menu on rightmost computer facing RESUS
2. Select “DAVE” application
3. At login screen:

• Username: mtsinai
• Password: mtsinai

5. Select “EVERS”
6. Select”Life Event”
7. Select “Death”
8. Select Start/Edit New Case
9. Fill out pages in sequence:

• Fill in Red Fields
• Validate each page
• Hit “next” after validation
• Press F12 for current date
• Do Not Abbreviate Cause Of Death

10. At biometric thumbprint entry, PUSH HARD (worked for me).

To print actual certificate:

• Go to “Death”
• Life Events
• Locate Case
• Enter Patient Name
• Search
• Click Patient Name
• Go to Forms
• Print Form (Nursing Administrators have special legal sized death certificate form which makes it official).

To obtain your password/thumbprint authentication – please call: Norfortiria Grant 49629 or Joshua Rochard 32505.