What is the protocol for completing a death certificate for a patient who died of unknown causes in a nursing home (Skilled Nursing Facility, SNF)?

From the Guidelines

When filling out a death certificate for a patient who died in a nursing home of unknown causes, it is essential to consult with the medical examiner or coroner in your jurisdiction and list "pending investigation" or "undetermined" as the cause of death until further information becomes available. This approach is supported by the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards, which emphasizes the importance of differentiating between cardiovascular and noncardiovascular causes of death, and notes that death certificates may not always provide accurate information 1.

To complete the death certificate, document the time and date of death accurately, and provide all demographic information about the deceased, including their full name, date of birth, social security number, and residence. It is also crucial to document any known chronic conditions the patient had, even if they weren't the direct cause of death, as these provide important context. Note the location of death as the specific nursing home with its address. If you were not the attending physician at the time of death but are familiar with the patient's medical history, indicate this clearly.

In cases of unknown cause, an autopsy may be recommended to determine the actual cause of death, which can later be used to amend the death certificate. The importance of thorough investigation and accurate documentation is highlighted in studies on sudden infant death syndrome, which emphasize the need for scene investigation, autopsy, and review of clinical history to determine the cause of death 1. However, in the context of a nursing home death, the primary concern is to ensure that the death certificate is completed accurately and thoroughly, with consultation from the medical examiner or coroner as needed.

Key points to consider when filling out a death certificate for a patient who died in a nursing home of unknown causes include:

• Consulting with the medical examiner or coroner in your jurisdiction
• Documenting the time and date of death accurately
• Listing "pending investigation" or "undetermined" as the cause of death until further information becomes available
• Providing all demographic information about the deceased
• Documenting any known chronic conditions the patient had
• Noting the location of death as the specific nursing home with its address
• Indicating if you were not the attending physician at the time of death but are familiar with the patient's medical history.

From the Research

Filling a Death Certificate for a Patient with Unknown Causes

When filling a death certificate for a patient who died in a nursing home of unknown causes, it is essential to consider the importance of autopsy in determining the cause of death.

• Autopsy can provide valuable information about the cause of death, which is crucial for public health strategies and for bereaved families 2.
• The autopsy rate has declined significantly over the years, with fewer than 5% of patients undergoing autopsies in American hospitals 3.
• In cases where autopsy is not possible, alternative methods such as minimally invasive autopsy (MIA) can be used to determine the cause of death, especially in developing countries 4.

Determining the Cause of Death

To determine the cause of death, the following steps can be taken:

• Consider performing an autopsy to provide a definitive diagnosis of the cause of death 2, 5.
• If autopsy is not possible, consider using alternative methods such as MIA to collect tissue samples and determine the cause of death 4.
• Review the patient's medical history and clinical records to identify any potential causes of death.
• Consult with other healthcare professionals, such as pathologists and forensic experts, to determine the cause of death.

Completing the Death Certificate

When completing the death certificate, it is essential to provide accurate and reliable information about the cause of death.

• Use the information gathered from the autopsy, MIA, or other diagnostic methods to determine the cause of death.
• Follow the standard guidelines and protocols for completing death certificates, and ensure that all required information is included.
• Be aware of the potential for errors or inaccuracies in death certification, and take steps to minimize these risks 2, 3.