Papers

Prospective audit of records of deceased patients received in hospital mortuary

Y L Hock, consultant histopathologist ^a, P Stewart, medical technical officer (mortuary) ^a, E Livesley, epidemiologist ^b. 

^a Walsall Hospitals NHS Trust, Walsall WS2 9PS, ^b Department of Public Health Medicine, Walsall Health Authority, Lichfield House, Walsall WS1 1TE

Correspondence to: Y L Hock Hocky{at}wht.walsallh-tr.wmids.nhs.uk

Mortuary services in hospitals have generally been given little attention by clinicians, the media, or the public. However, recent stories about improper storage of bodies and organs have generated public interest in both pathology and mortuary services.^1-3

Response to the media stories shows that the public expects the standards of care and attention given to the deceased to be the same as those for living patients. However, our experience, and that of pathology colleagues, suggests that clinical staff do not pay enough attention to the documentation related to deceased patients. Although this is understandable given the increasing workload of clinical staff and staff shortages, it is unacceptable. To investigate the errors or omissions in the documentation accompanying deceased patients, we audited the documents accompanying all deceased patients in the hospital over four years.

	Methods and results

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We prospectively audited the documentation relating to 7761 bodies received in the mortuary of the Walsall Hospitals NHS Trust during 1996-2000. Bodies were received from funeral directors and ambulance crews as well as hospital wards. We checked wrist bands, labels, and identification papers against the patients' registration details on the hospital patient management system for any discrepancies. We also checked accuracy of recording the presence of a pacemaker and property for each body. Bodies for which there was one or more discrepancy were classified as failed cases. Annual failure rates are expressed as the percentage of failures in a financial year (April to March). The study was part of an ongoing internal quality assurance audit, and ward managers and funeral directors were sent memorandums pointing out any errors and omissions every six months.

In 1996-7, the failure rate for bodies from all sources was 10.2% (table). This figure fell in the study period to 2.9% in 1999-2000. The bodies received from the hospital accounted for most cases of failed documentation. When the failure rate was calculated for hospital deaths alone, it fell from 11.9% in 1996-7 to 4.0% in 1999-2000.

	Comment

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That the documentation of about 10% of deceased patients contained errors at the beginning of the study suggests that clinical staff were paying insufficient attention to the identification and details of deceased patients. Although some of the discrepancies were arguably less important, such as errors in unit number or address, a substantial proportion could have had serious consequences. These include misidentification of the body (body received in the mortuary with the wrong name) or property and non-notification of pacemakers.

Pathology is one of the most intensely scrutinised medical specialties. Clinical Pathology Accreditation (UK) sets standards for medical laboratories and mortuaries and insists on external quality control measures and regular internal audits. However, the mandatory quality assurance procedures refer only to the internal quality control of all examinations and do not specifically refer to mortuary services.⁴ Our experience of inspections by Clinical Pathology Accreditation is that little emphasis is put on regular internal quality control audit of the mortuary or on any other internal quality assurance procedures. The error rate fell during our study, probably because staff were regularly alerted to errors as part of the audit. We therefore believe that such audits are essential for a mortuary to run effectively and safely and to gain public confidence.

	Acknowledgments

We thank Colin Humphries and Rachel Jones for collecting routine data and Tony Board for suggesting a regular mortuary audit. We also thank Angela Turner for typing the manuscript.

Contributors: PS was responsible for initiating and coordinating the audit and data analysis. YLH was responsible for reviewing the literature, interpreting the results, and writing and editing the paper. EL was responsible for statistical analysis and also helped edit the paper. YLH is the guarantor.

	Footnotes

Funding: None.

Competing interests: None declared.

	References

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1.	Lawrence J. Milburn blames hospitals manager for allowing corpses to be left on chapel floor. Independent 2001 Jan 17. www.independent.co.uk/story.jsp?story=51331 (accessed 8 Jan 2002).
2.	Carvel J, Branigan T. Hospital admits storing 12 bodies in boilerhouse. Guardian 2001 Jan 19. www.guardian.co.uk/Archive/Article/0,4273,4119764,00.html (accessed 8 Jan 2002).
3.	Hunter M. Alder Hey report condemns doctors, management, and coroner. BMJ 2001; 322: 255[Free Full Text].
4.	Clinical Pathology Accreditation (UK) Ltd. Standards for the medical laboratory. www.cpa-uk.co.uk (accessed 27 Mar 2001).

(Accepted 22 October 2001)