Intended for healthcare professionals

Practice The Competent Novice

Managing sudden death in hospital

BMJ 2010; 340 doi: (Published 13 April 2010) Cite this as: BMJ 2010;340:c962
  1. Paul J Frost, consultant in intensive care medicine1, senior lecturer2,
  2. Stephen Leadbeatter, senior lecturer in forensic pathology3,
  3. Matt P Wise, consultant in intensive care medicine1
  1. 1Critical Care Directorate, University Hospital of Wales, Cardiff CF14 4XW
  2. 2Cardiff University Schoool of Medicine, University Hospital of Wales, Cardiff
  3. 3Department of Medical Genetics, Pathology and Haematology, University Hospital of Wales, Cardiff CF14 4XW
  1. Correspondence to: P J Frost Paul.Frost{at}
  • Accepted 4 February 2010

Junior doctors play an important role in verifying sudden deaths in hospital and communicating with the family of the deceased. This article covers England and Wales; the situation in Scotland and Northern Ireland differs in some respects

Key points

  • A minimum of five minutes of continuous observation is required to confirm irreversible cardiorespiratory arrest

  • Families consider that privacy, clarity of message, the ability to answer questions, and a caring attitude are the most important aspects of imparting bad news

  • Consider organ and tissue donation even when the death is unexpected

  • Junior doctors must meet legal requirements before completing death certificates and must know when to refer a death to the coroner; if uncertain, they should discuss with a senior colleague

  • Informal discussion with senior colleagues and peers can help in coping with the emotional impact of dealing with sudden death

Deaths in hospital are common: in 2008-9, 246 525 people died in English NHS institutions alone.1 Such deaths may be anticipated or sudden and unexpected; they may result from disease or from trauma.2 Unexpected, and often premature, deaths can be challenging to manage: the family may have had no time to prepare for the bereavement, and they may not even be aware that the deceased had been admitted to hospital (see case 1 and 2 scenarios, part 1). Information necessary for the death to be managed sensitively (for example, about the person’s cultural and religious beliefs) may be unavailable. A death whose cause is unknown or unnatural will prompt a coroner’s inquest and perhaps a criminal investigation. Sudden deaths often occur in acute care areas, such as the emergency department, where clinical pressures conspire to divert the focus of care from the deceased’s family. These circumstances increase the potential for suboptimal care, adding to a family’s distress.

Case 1 scenario: part 1

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