End of Life Care — Non-Medical Examiner Case — Clinical Pathway: Emergency

End of Life Care Clinical Pathway — Emergency Department

Non-Medical Examiner Case


Follow Autopsy Policy - View Patient Care Manual

Contact Dan Corwin or Eron Friedlaender for guidance for completing this process.

MD: Documentation/Communication (Available in EPIC Discharge Navigator)

Preliminary Cause of Death
  • Must be completed
Dispo & Follow Up
  • Click the magnifying glass next to the disposition field
  • Select Deceased-Medical Examiner or Deceased-Morgue
Autopsy/Permission for Autopsy Form
  • In Letters Section in EPIC under CHOP IP Autopsy Consent
  • Discuss with any subspecialists who follow patient closely to see if there is reason to encourage family to obtain autopsy
  • Discuss with family
  • If family agrees to autopsy:
    1. Print out the “Permission for Autopsy” letter in Epic to obtain signatures for consent
    2. Notify the attending physician that an autopsy is to be performed (CMS regulatory requirement)
Death Report and Pathology Consultation Report
  • Complete Deceased Checklist in EPIC
  • In the Summary activity, click the magnifying glass, and search Pathology Consult Report
  • Print this report and give to nurse to accompany body to morgue
  • Fill out only if family agrees to autopsy
  • Autopsy Follow-up
    • Attending Physician who will follow-up with autopsy results provides contact number; provide the name of the provider most familiar with the patient’s overall care, can be a subspecialty attending (this is the person to whom Pathology may reach out with specific questions about the patient)
  • Provider (MD/APP) should print out COMPLETE ED PROVIDER NOTE to accompany body to morgue
Certificate of Death Complete an Electronic Death Certificate
FORMS NOT TO FILL OUT
  • Medical Examiner’s Notice and Pronouncement of Death Form

RN: Documentation/Body Preparation

Initial Body Preparation
  • Place in clean gown, close eyes, lift jaw, arrange in supine position
  • Move to Room 6 or BH Room (if Team 8 closed)
Lines/Tubes
  • Endotracheal or LMA tube may be cut to the lips
  • Do NOT remove:
    • Chest tubes
    • IV access: IO, IV lines, PICC
  • Do NOT circle on body where prior lines/tubes were placed
Belongings
  • Gather all belongings and place in plastic bag to give to family
EPIC Documentation
  • Complete End of Life Flowsheet in EPIC
  • Progress Note
    • Document each interaction with the deceased and/or family utilizing the dot phrase “.edbereavement” to capture family and staff presence and support provided.
Keepsakes
  • If Child Life unavailable (M-F 1a.m.-7a.m., Sat-Sun 1a.m.-8:30a.m.) assist in keepsake process (handprints, pictures, locks of hair) with ME and family
  • Note
    • ME will allow keepsakes the majority of the time
    • If ME staff communicating with CHOP MD denies request, please confirm with the Medical Examiner on call
Non-ME Case Body Disposition
  • Body will be transferred to morgue unless family wishes to pick up from ED
  • Label ID tags in body bag kit
  • Attach ID tag to right great toe/right ankle
  • Wrap in disposable sheet/blanket and place in body bag; attach ID tag to body bag
  • Documentation to accompany patient to Morgue
    • Certificate of Death
    • Permission for Autopsy (if applicable)
    • Physician Note If Available
  • Contact security for escort to morgue