Martin Goddard FAAPT gives his account of the introduction of Medical Examiners (ME)
Having read an excellent report by Rachel Carline on the recent meeting at the Royal College of Physicians about the introduction of Medical Examiners (ME) it is difficult to know what new information to present to the profession that adds any value.
Having said that perhaps the most sensible thing to do is look at the proposals and see what practical aspects we, as APTs, should consider. What arrangements will we need to make to accommodate extra visitors to our departments, will it cause delays, is it going to result in an increase of work for our departments?
It seems an odd collection of questions to ask given that we were told that the service has been over a decade in making but by the panel’s admission they still don’t have all answers. From the Mortuary perspective a lot of this seemed to be because there is no formal guidance on how a Medical Examiners system should be structured in terms of physical location, who could fill the roles of Medical Examiners Officers (MEOs) and management of these staff.
One thing that did cause me some concern was the number of parties that were mentioned as being consulted (even down to Portering staff) yet only on one occasion were APTs mentioned. It could be that we have been heavily consulted in areas where ME services exist but there wasn’t much acknowledgement of that fact. It seemed that the day was intended to sell the idea of the ME service being the best thing since sliced bread… but is it? The best way to answer any question or formulate an opinion is to look at the facts.
April 2019 will see the introduction of a non statutory ME service throughout NHS hospitals. The service will analyse the notes of all patients who die in hospitals to ensure that any failures in care are identified and flagged to the relevant governance teams. The will also advise Doctors if a death should be referred to a Coroner. What they will not do is decide upon a cause of death and instruct the issuing Doctor (referred to as Qualifying Attending Physician QAP) what to write on an MCCD.
It was estimated that an ME or MEO could assess a set of notes on average in 15 – 20 minutes. The ME or Senior MEO will also speak with each family to ensure they are happy with the cause of death and care provided. Once the ME is satisfied the ME will complete part 5 of the cremation form and the patient will be clear for collection by funeral services pending completion of any local release documents and procedures.
So let’s break this process down to see what effect it could have on us.
Notes will need to arrive at a central point to be assessed. This could be a Bereavement Office, Mortuary or possibly an MEs Office. Have a think about your local process and consider what this could mean for you. For example my department is co-located with Bereavement which I also manage so we receive all notes here when the patients are transferred. This will mean that I will have to expect an ME and an MEO to attend my department each day and potentially use some of my limited office space to make calls to families and examine notes. I’ll probably need extra phone lines, designate quiet office space for phone calls and need extra IT.
The MEOs will need to be permanently based somewhere and also be put under someone’s umbrella of management. At the meeting it was suggested that each Trust should use resources in place such as Bereavement Officers to triage cases in fact MEOs can be a role combined with the Bereavement Officer’s. If that is the case and you manage the Bereavement services also will staff need rebanding? Will you require additional staff to make your service robust and if so all of the resources mentioned in the previous paragraph also need to be considered.
This process takes extra time, there are no two ways about it. This will have a knock on effect to Mortuary capacity.
We gleaned on the day that the delay would only be around an extra half a day on average however in my Mortuary half a day could be a big issue, it’s the difference between a patient who dies on Monday who would have left on Friday afternoon and would now be with us for the weekend and leaving on the Monday. So with that in mind do we have sufficient fridge space available throughout the year and particularly over peak pressure times such as Christmas. Are our existing systems for release as slick as possible to ensure patients leave us as soon as the possibly could. When Bereavement came to the Mortuary here in Exeter we did a lot of work with Service development to streamline all of our processes and get patients back to their families with the minimum of delays. With the ME service coming we will have to revisit that work and redesign certain elements to make sure we don’t end up where we started. The other issue to factor in is the increase in phone calls from funeral services, families and so on. Will we need extra admin or APT resources to cope with that increase?
These are just three issues that should be thought through, there are plenty more but I think these are the big ones. So is the juice worth the squeeze? Is there any point to introducing yet another layer of bureaucracy into what is an already complicated process? Yes it is a pain from a practical perspective but when we consider why this service was first suggested there are benefits. We all need to remember that the Bereaved and their care should be at the centre of our practice.
The ME service is there to ensure that the bereaved have an understanding of why their loved one died, they have a voice if they have a concern about the care their loved one received and finally to stop mistakes from recurring which could lead to patient harm or worse death. Whatever your feelings are, and we all have one for or against, the ME service is coming, maybe not a quickly as some would like but its arrival is indisputable.
How that service works in our organisations is to be seen but we could do far worse than try to get in at the initial stages and try to form a service that we have some on running influence over. If we don’t the chances are we could be left in a difficult position.
Martin Goddard FAAPT