The deceased deserve better: Why they should be a higher hospital priority

Each year, about 984,000 people die in U.S. hospitals, according to the CDC. Yet many hospital leaders underestimate the importance of having strong decedent management procedures in place. Decedent management-related errors—such as misplacing deceased patients or sending them to the wrong funeral home—cause emotional harm to deceased patients’ loved ones, and create significant compliance and liability problems for hospitals.

The Covid-19 pandemic has underscored just how high the stakes are when it comes to decedent management—and how likely it is for traditional decedent management approaches to buckle under pressure. Throughout the pandemic, many hospitals have struggled to accurately, efficiently, and compassionately handle the increase in deceased patients.

As of mid-August 2020, over 170,000 Americans had succumbed to the virus, and according to the CDC, about 35% of American deaths occur in a hospital each year. If this percentage holds true for Covid-19 patients, it means that U.S. hospitals will have managed nearly 60,000 additional deaths in less than half a year.   

The High Cost Of Failed Decedent Management
Poor decedent management has significant negative consequences for hospitals and health systems. Errors related to the handling of patient remains can not only create emotional distress for patients’ family members, but can be costly. Recently, a Tampa hospital was sued for losing the body of a deceased newborn.

Poor decedent management also makes it likely that hospitals will fail to comply with numerous regulatory and licensing bodies. For example, The Joint Commission has strict regulations for documenting signed consent and for meeting other requirements related to organ and tissue donations and autopsies.

Hospitals must also adhere to city and state requirements—such as those related to completing death certificates in a timely manner. Tennessee, for example, requires physicians to sign death certificates within 48 hours.

VA hospitals face even more compliance rules. They must adhere to VA-specific requirements (such as those related to the processing of death certificates), as well as all other city and state laws and regulations related to decedent management.

Why Managing Decedents Too Often Fails
Decedent management is a surprisingly complex set of tasks that involves several stakeholders, including physicians, nurses, transporters, and hospital morgue and crematory staff. Outside the hospital walls, the story is equally complex, typically involving mortuaries, funeral homes, medical examiner offices, and various government agencies.

A growing number of hospitals are recognizing the value of having a department to manage these tasks, typically called an Office of Decedent Affairs (ODA).  In addition to being responsible for tracking, transporting, documenting, and monitoring patient remains, the ODA must communicate with decedents’ family members and support them through difficult decisions, such as those related to autopsies or organ and tissue donation.

The ODA also must ensure ongoing communication with internal stakeholders such as transport staff and clinicians, and coordinate with outside partners like funeral homes, medical examiners and organ donation organizations. Timely and accurate reporting of deceased patient information to local, state, and federal agencies and complying with city, state, federal, and Joint Commission requirements is also essential.

A New Approach Needed
Despite the high stakes involved, many hospitals rely on manual, paper-based tracking and management systems to accomplish decedent management tasks. This is not solely due to oversight. There is surprisingly little technology available to help hospitals with decedent management.

Some hospitals, such as The University of Pittsburgh Medical Center, have even built their own in-house tracking systems to help better coordinate care.

Others have pioneered a different approach. After confronting the absence of decedent management solutions in the market, for example, one Missouri-based hospital worked with its supply chain solution partner to develop the software it needed.

The platform is freeing staff to spend more time on direct patient care, ensures that decedent affairs processes are being handled compassionately, keeps all internal and external stakeholders informed, and expedites the cumbersome documentation and reporting requirements of local, state, and federal governments. Importantly, it is also reducing the risk of lawsuits from disgruntled families. The hospital is also experiencing an increase in organ/tissue recovery and donation, as well as higher autopsy rates.

An ideal decedent management technology solution should include:

• Tools that can be modified as needs change
• Pre-configured protocols that ensure compliance
• Integrated RFID/RTLS or system-level scanning technologies for tracking
• Case tracking dashboards that show decedent status in real time
• Task-driven work plans and workflows for each type of decedent
• Pre-populated data from the EHR and registration systems
• Case inventory/storage management in morgues
• Tracking of communicable diseases and capturing isolation risk

As hospitals increasingly focus on delivering an excellent patient and family experience throughout the entire patient journey, updating and optimizing decedent management processes should be a top priority. Treating patients with dignity through the end of life has never been more important. It’s time that our healthcare system steps up to deliver.

Photo: DeoSum, Getty Images

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