Authors (including presenting author) :
Lui BKP(1), Yuen WM(1), Li PY(1), Kwok WH(1), Lai TW(1), Siu ML(1),
Mak PKF(1), LeungYL(1), KngPLC(1) , LeungYYJ(1)
Affiliation :
(1)Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin
Hospitals
Introduction :
Timely completion of the Medical Certificate of the Cause of Death (Form 18) & Cremation (Form 2) underlines our basic support for bereaved families. Delay leads to inconvenience for families at a time of grief and precipitate complaints. Yet, frontline doctors with heavy workload may not prioritise such paperwork.
Objectives :
Based on input from doctors, this paper studied the feasibility to empower clerks to assist in preparing death certificates for doctors, in order to free up doctors time for clinical duties and to enable timely receipt of certificates for bereaved families.
Methodology :
The 5 steps involved (a) working group and engagement of frontline doctors, nurses and clerk to design the workflow, (b) role and responsibilities were defined, (c) training and supportive coaching of clerk by nurses using practice kit template illustrating items to be filled in by clerks, standardized chop to reduce handwritten entry, then safety check steps by nurse and alleviating clerks’ anxiety, (d) team briefing of nurses, clerks and doctors, and (e) test run in pilot ward for workflow. Feedback was obtained, workflow fine-tuned and the process was extended to other wards
Result & Outcome :
Following a 3 month trial run, the workflow was tested in 87 deaths with 39 male and 48 female patients. Initially, 8% had minor wrong entries (e.g. wrong words found in patient’s name; missing entry of time of death) which were detected by nurses, and gentle feedback to clerks. Based on interviewing with frontline doctors, the time for writing the death certificate was reduced from 10 minutes to 5 minutes. Positive feedback was obtained. Importantly, we reduced the delay from death to issue of death certificate and cremation form to families from 72 hours to within 24-36 hours of death.This simple intervention is achieved through teamwork between clerks, doctors and nurses as a practical means of supporting families in their bereavement. A win-win-win result to empower clerks, reduce frontline doctors’ workload and improve patient/ family experience with an efficient model that is applicable to all wards.
