Discharge as Deceased Navigator
A unique patient navigation workflow is needed when a patient dies in a healthcare facility, including when they are declared dead on arrival at the facility. This "patient movement" is a form of discharge, with death bringing the associated healthcare encounter to an end. The workflow is supported with a navigator.
Discharge as Deceased Navigator
A "Discharge as Deceased" navigator is found within the Discharge activity, with slight variations in how the navigator is initiated for emergency department encounters.
Emergency department
With a patient chart open and the "Dispo" activity selected, find the "Disposition" section and enter a disposition fitting the death circumstance (e.g., died in ED).
This will reveal a new section in the Dispo activity called "Death Documentation". Select the section link to open the "Discharge as Deceased" navigator.
Inpatient departments
With a patient chart open and the "Discharge" activity selected, look for and select the tab labelled "Discharge as Deceased".
The following information relates to tasks that prescribers must complete, guided by the navigator.
Essential Steps for Prescribers
The Discharge as Deceased navigator is available to all clinicians. The version presented for signed-on prescribers highlights just the tasks with physician accountabilities, and so differs from what is shown to nursing and non-prescribers.
Prescribers must use the Discharge-as-Deceased navigator to review key information, take actions and complete all required documentation:
Review eligibility criteria
for organ or tissue donation, medical examiner notification and autopsy requests.Reconcile problems
by indicating which hospital problems are resolved and which were active at the time of death; plus confirming a principal problem that was the focus of the inpatient encounter.Clear orders needing co-signs
Declare the Date, Time and Preliminary Cause of death
where the date and time correspond to the instant when a bedside assessment to pronounce death is completed.Contact and notify
the attending provider as well as the patient's designated decision-maker(s), noting who was contacted.Complete a pronouncement of death progress note
Complete a discharge-as-deceased discharge summary
Ensure attending physician completion of a medical certificate of death
Confirm completion of all required tasks
using the provided Discharge Checklist.
Donation Criteria
The Deceased Navigator has an interactive "Review Eligibility Criteria" section that helps clinicians review criteria that must be met in order for a deceased patient to become a tissue or organ donor. Answers to basic questions may expose more detailed questions or instructions for appropriate actions. The section summarizes the status of review tasks, while providing links to popup displays of the state of all questions that relate to a task. Instructions are embedded within the section, including a prompt to click on link(s) to open an editor for reviewing and updating eligibility data.
Medical Examiner Notification
The same "Eligibility Criteria" section that helps clinicians review criteria that must be considered to determine whether the Office of the Medical Examiner (ME) must be contacted in compliance with the Alberta Fatalities Act.
Calgary (southern Alberta)
Phone 403-297-8123; Fax 403-297-3429; Email ocme_admin@gov.ab.ca
Edmonton (northern Alberta)
Phone 780-4274987; Fax 780-422-1265; Email ocme-admin@gov.ab.ca
Autopsy Consent and Request
Prescribers and/or families may request an autopsy. This possibility is also covered with the "Eligibility Criteria" section of the "Discharge as Deceased" navigator. If an autopsy is requested, family consent should be obtained and a link is provided to the relevant form for printing and signing (soon to be replaced by a digital consent workflow with e-signature).
Currently, the same print-optimized autopsy consent form includes a section where the responsible provider must enter any clinical questions to be answered. In future, this autopsy consultation request will be separated and handled like other investigation requests in Connect Care.
Medical Certificate of Death
The Province of Alberta is working on, but does not yet support, digital death certification. At this time, responsible physicians must complete a formal (paper) death certificate in the event of a patient death. These can be found at Emergency or Nursing Station forms stores. They can also be obtained from the facility admitting department and must be returned to medical records before a body can be released.
Date, Time and Preliminary Cause of Death
The Discharge-as-Deceased navigator has an important section that facilitates capture of the physician-declared date and time of death. This must correspond to the instant when a bedside or otherwise direct assessment for signs confirming death has been completed. A preliminary cause of death must also be entered. This can be as general or specific as the completing physician feels appropriate. It may be revised later when or if additional information becomes available.
Entering the structured information in the form provided is mandatory. That information then flows into other required documentation.
Death Pronouncement Progress Note
Pronouncement of a patient's death must be documented in the legal record of care. This is done in Connect Care by entering a progress note recording the findings of the prescriber assessing the patient for signs of death.
The Discharge-as-Deceased navigator has a section that provides interactive links for reviewing and/or updating key structured data, such as whether and how a patient's designated decision maker was contacted. Another clearly labelled link will initiate a progress note using a standardized format. This includes key information that must be in a pronouncement. In most cases, the default values can be accepted.
SmartLink: .PRONOUNCEDEATH
Discharge Summary for a Deceased Patient
Discharge summaries are required documentation for all inpatient encounters. However, there are specific content requirements when discharge is because of death.
Discharge Checklist
A final section within the Discharge-as-Deceased navigator displays a copy of the chart "Discharge Checklist". This lists required actions and documentation, indicating whether the tasks have been completed or not. Any deficient task can be clicked (selected) to jump to a tool for resolving the deficiency.