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Hospital bereavement service led by matron helps relatives

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Heavily involving senior nurses, such as matrons, in hospital bereavement services may help relatives to deal with concerns over care in the wake of a difficult death and ultimately curb legal action, according to researchers in Kent.

Bereavement services that are led by senior nurses and doctors, plus the person responsible for quality and safety at the hospital, may reduce patient complaints and legal action in the wake of a difficult death, suggest the results of a pilot study.

“It is our view that families should not have to litigate or complain to get answers or raise concerns”

Study authors

The pilot was carried out at one acute provider, Medway NHS Foundation Trust, with the results published online in the journal BMJ Supportive & Palliative Care.

Families who use hospital bereavement services often do so because they have unanswered questions about the diagnosis or treatment of the person who has died and/or issues around the quality of the care provided, noted the study authors.

They highlighted that complaints and legal action were both more likely when relatives feel their questions have not been answered satisfactorily or steps not taken to stave off the likelihood of a repeat of similar circumstances.

The researchers wanted to find out if a hospital bereavement service led by senior clinicians and the quality and safety lead might lower the risk of complaints, coroners’ inquests, and legal proceedings, as well as help relatives cope better with a difficult death.

The used the Medway Model under which relatives are contacted the next working day after their loved one’s death and invited to a one-hour semi-structured meeting at the hospital with the relevant specialist doctor and the matron on whose ward the patient died.

“Further research is required to elucidate whether such a service, if rolled out nationally, would reduce costs”

Study authors

Meetings were held sooner if the death was the subject of an inquest, to reduce the coroner’s workload and better prepare families, noted the study authors.

At the meeting, relatives are encouraged to describe their version of events, and to expect to get answers to their specific issues and concerns. Formal minutes are taken by the hospital’s surgical lead for quality and safety, and actions agreed.

Within a week of the meeting, minutes are sent to relatives, who are informed of the results of any further investigations, and their anonymised feedback is given to all involved in the patient’s care.

The pilot service applied only to deaths following surgical procedures between May 2017 and January 2018, during which 121 invitations were sent out, and 15% of families took up the offer.

The majority, 83%, of the families had unanswered questions about the clinical care given to their relative, while 78% had questions about the quality of care provided and 12% had questions about both.

The most common clinical themes related to the management or treatment of their loved one, the timing of investigations, and whether anything could have saved his or her life.

The most common issues of concern were about the quality of nursing care, communication with and between various health professionals, and the need for reassurances that other patients wouldn’t have to experience what they had been through.

Analysis of the feedback forms showed that 44% of respondents would have made a formal complaint had they not been able to get answers to their questions. Two families had already sought legal advice, but neither went ahead after the meeting.

Most of those, 78%, who used the service said they had obtained closure, with the remainder awaiting further information which wasn’t available at the meeting. An added bonus was the ability to involve families in investigations into serious incidents, said the researchers.

“Many other models [of bereavement care] appear to provide counselling or other psychological support, rather than specifically aim to reduce complaints, inquests and litigation through providing answers to questions or direct discussion about issues of governance,” they said.

“It is our view that families should not have to litigate or complain to get answers or raise concerns following the death of a loved one. They should have a right to access this through the hospital services,” they added.

The pilot study was based on surgical cases alone at one hospital trust, and so may not be applicable elsewhere, but it may be worth exploring further, according to the authors.

“Further research is required to elucidate whether such a service, if rolled out nationally, would reduce the costs on the NHS from complaints and litigation,” they said.

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