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Reporting criteria for hospital deaths

Step 1: Are you entitled to certify death?

To complete the MCCD, you must be a doctor with a GMC licence to practise medicine and you must have "been in attendance during the deceased's last illness". "Attended" means that the doctor was in some way involved in the care and had familiarity with the deceased's medical condition and preferably would have looked at the notes.

If you are entitled to certify death then you actually have a duty to certify death unless you know another doctor will be doing it. It is not optional.

A hospital death should also be reported by a senior doctor.

Step 2: Inform the coroner if:

  1. Cause of death or identity of the deceased is unknown.
  2. The deceased was not seen by the certifying doctor either within 14 days before death or after death.
  3. The death was violent or suspicious.
  4. The cause of death is not natural. This would include:
    a. Death was contributed to by an accident (wherever or whenever this occurred)
    b. Death may be due to neglect by others or self-neglect
    c. Death due to termination of pregnancy
    d. Possible suicide
  5. Death occurred during an operation or before recovery from the effects of an
  6. Death may be due to industrial disease or related to the deceased's employment.
  7. The death occurred during or shortly after detention in police, prison or mental health
  8. Death is caused/contributed to by a medical procedure.
  9. There are concerns about the deceased's medical treatment - whether felt to be justified
    or not. 

If (and only if) the above criteria do not apply, then it is no longer necessary to report the following:

  1. All child deaths.
  2. DOLS deaths.
  3. Deaths occurring within 24 hours of admission (NB unless one of the above criteria applies).
  4. All falls, unless it is felt that the fall has contributed to the death (i.e. part 1 or part 2 of the cause of death).
  5. Deaths where there has been a procedure within 12 months unless the cause of death is linked to this.

When a death is referred to the coroner it is imperative that all relevant information is shared. The reporting doctor should be familiar with the patient's medical history, investigations and treatment and should have access to the records at the time of reporting. If it is felt that a cause of death cannot be given, on the basis of "best knowledge and belief", it should be confirmed that the case has been discussed at consultant level (this may include an ME) and reasons should be given for this. You should expect to be contacted if no adequate explanation is provided.

Part 2 still counts! A cause should only be recorded (in part 1 or part 2) if it has contributed to the death. "Contributed" in this context means it is likely to have played a more than minimal role in leading to the death. A #NOF in part 2 is still reportable to the coroner. Never include all of the deceased's PMH automatically. Include only matters which have contributed - or leave them out of the cause of death.

Step 3: How to complete the MCCD

It is vital to remember that, in completing an MCCD, the standard to be applied is "best knowledge and belief". The doctor completing the MCCD does not need to be certain. Doctors reporting deaths will often state "Well, I am not sure...". This is a doctor who has not understood the test that needs to be applied.

Once a death is referred to the coroner, the reporting doctor may not issue an MCCD until the cause of death has been agreed with the coroner.

When the MCCD is agreed with the coroner, the doctor signing the MCCD must indicate that the coroner has been informed and must record the exact words agreed with the coroner (with no abbreviations).

All hospital deaths will be discussed with medical examiners, including those being referred to the coroner.

To avoid the registrar rejecting the MCCD, doctors should ensure:

  1. The correct spelling of the deceased's full name.
  2. The correct date of death, age and usual address is given.
  3. The cause of death has within it a diagnosis and not only a mode of death.
  4. The cause of death avoids terms that might be due to unnatural causes (e.g. haemorrhage, perforation) unless it specifies a natural cause for that process (e.g. spontaneous haemorrhage).
  5. "Old age" may be given as the cause of death when the doctor caring for the patient has observed a gradual decline in general health and functioning, the patient is more than 80 years old and no other disease process can be specified as causing death.

Mrs Heidi J. Connor
Senior Coroner for Berkshire

pdf icon Downloadable version of reporting criteria for hospital deaths [123kb]

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