When the patient dies: a survey of medical housestaff about care after death

Our objectives were to determine medical housestaff exposure to the tasks of care after a death in the hospital and to characterize their practices, training, and attitudes toward this care. The study design was a review of hospital records and survey of housestaff at two academic medical centers. Forty-seven of 239 medical housestaff were surveyed. In one of the two hospitals studied, the number of death certificates completed by interns during 1 year was determined, and an estimate of exposure to hospital deaths and three other common discharge diagnoses during the same period was calculated. Housestaff were surveyed about the tasks of care after a death, including the determination of death, preparation of the body, notification of family, documentation, review of death with staff, and follow-up with family. Interns at one hospital completed a death certificate an average of 7 (range 1 to 13) times a year and were involved annually with approximately 30 inpatient deaths on ward teams. Exposure to a hospital death was comparable in frequency to that for pneumonia (48 cases/yr), congestive heart failure (32 cases/yr), or AIDS (24 cases/hr). Housestaff reported little or no formal training for the tasks of care after a death. Considerable variation among housestaff was noted in such routine tasks as how death was determined, discussions with the family, and providing bereavement care. Only 12% of respondents regularly reviewed personal reactions to a death with the medical team. In response to open-ended questioning, housestaff described significant distress and uncertainty regarding their roles in completing the tasks of care after a patient death. Medical housestaff are regularly exposed to hospital deaths, yet report minimal training, wide variations in practice, and significant distress with the performance of tasks after a death. We encourage greater attention to teaching about this important area of medical practice.