T

he woman’s death, one of almost a thousand every year at a major Boston teaching hospital, was nothing unusual, until her body was shipped to the wrong funeral home.

The mixup delayed the funeral, caused the family distress — and helped prompt Beth Israel Deaconess Medical Center to examine how it handles patients’ bodies and supports family members after a death.

The issue has received little attention nationally, though the National Center for Health Statistics has found that about one-third of deaths in the United States occur in general hospitals.

advertisement

“We’re shedding a light on an area that has not been shed a light on,” said Dr. Lauge Sokol-Hessner, associate director of inpatient quality at Beth Israel Deaconess.

The hospital has created a 20-person working group to focus on the aftermath of a patient’s death. It’s part of a broader effort to reduce “insults to dignity” — mistakes that cause emotional harm, but haven’t traditionally been considered medical errors.

For example, after another woman died at the hospital, her family got to the funeral home and couldn’t find her pocketbook, said Patricia Folcarelli, senior director of patient safety. It turned out the pocketbook was still in the hospital morgue.

In another case, the hospital failed to complete an autopsy that a family had requested, she said.

These cases happen with low frequency, but have high impact, Folcarelli said.

“If something about the death doesn’t sit well with the family members, they’re at higher risk of complicated grief” — when grief gets “stuck” or turns into depression, added Kathleen Rimer, the hospital’s director of spiritual care.

The case of the misplaced body stemmed from a miscommunication between the hospital and the funeral home, which picked up the wrong body from the morgue, Sokol-Hessner said.

Hospitals have spent a lot of money studying patient “handoffs,” or transitions of care for living patients, but “this is one transition we hadn’t thought a lot about,” he said. His team has found no research on these post-mortem transitions.

“I don’t think anybody’s thought systematically about this process,” he said.

“It’s hard to talk about death,” Sokol-Hessner said. There are also no regulations for how hospitals handle dead patients, he added.

When a patient dies, a physician pronounces the death, nurses prepare the body, and a transport worker takes the body to the basement morgue, where a pathologist might conduct an autopsy. Other steps involve a wide range of staff.

Insults to dignity Beth Israel Deaconess
Patricia Folcarelli, Debra Barbuto, and Carolyn Wheaton (from left) are part of a 20-person working group at Beth Israel Deaconess to focus on the aftermath of a patient’s death. Aram Boghosian for STAT

“It’s not coordinated,” Folcarelli said. Families “get the runaround” and end up making lots of phone calls to track down documents and personal belongings. They feel “a sense that the death happens, and everybody else just moves on.”

The post-mortem process is so complex that Folcarelli and her colleagues created an intricate “death map” outlining dozens of steps that happen when a patient dies. As in any hospital process, an error can happen at any step.

For instance, staff have to report a death in an online state database. If they miss a field in the data entry, that could delay the death certificate — which could trip up family members who need that document to get discounted airline tickets for the funeral, explained Barbara Sarnoff Lee, the hospital’s director of social work and patient/family engagement.

Getting an autopsy report can be frustrating, too: Families may have to wait up to eight weeks between an autopsy and autopsy report. And sometimes they later find out they can’t see the report at all, because the hospital is barred by law from releasing it to anyone but the executor of the estate, Sarnoff Lee said. She said the hospital aims to communicate better with families about what to expect.

Randy Gonchar, who sits on the hospital’s Patient-Family Advisory Council, welcomed the effort to improve a process he’s too familiar with. His mother, father, brother, and nephew all died at Boston hospitals.

Hospitals “didn’t really do anything” to help his family when each person died, he said — except Beth Israel Deaconess did transfer his mother to a private room as the end drew near.

Gonchar said his mother died there six years ago on the Fourth of July, right after the fireworks stopped. He was at her bedside with his wife.

“At that point, all we did was walk out of the hospital,” he said.

After a death, that walk from hospital to parking lot can feel long and lonely, Gonchar said. He suggested the hospital offer to escort family members to their cars, especially if they are alone. He also supports an idea the hospital is considering — to assign a single point person, or perhaps create a new position called a “death navigator,” to help families cope with the emotional and logistical hurdles surrounding a death.

Meanwhile, hospital staff have been trying out the Pause, a practice started at the University of Virginia in which staff gather around the body for a moment of silence after a patient dies. The Pause aims to offer closure and “acknowledge the gravity of what just happened,” said Rimer, the spiritual care director.

Jennifer Manzo, a nurse in the medical intensive care unit, said staff there see at least two deaths per week. Patients arrive very sick, often with liver failure or other organs shutting down. Manzo said she tried the Pause a few weeks after Rimer explained the idea.

It was early in the morning, she said. Her pager went off: A patient’s heart had stopped. She ran to the room. After a flurry of chest compressions and beeping alarms, it became clear that the 10-person medical team wasn’t going to save the patient. He died before his family could get there.

“I think we should take a minute to pause and recognize this man’s life,” Manzo recalled saying.

Only later did Manzo realize that the dead man’s roommate had been sitting in the room the whole time.

“I felt horrible for him,” she said. Usually staff try to relocate the roommate if a patient is about to die.

Manzo said she apologized to the roommate. He wasn’t upset. Instead, he gave her a hug.

Rimer said she hopes to spread the “Pause” to more parts of the hospital. She also plans to enhance the “comfort cart” that delivers food to families of dying patients: She’d like to add muffins, sandwiches, and softer tissues.

“We want people to feel cared for in this very difficult time,” she said. “It’s a real gift to give a family a death about which they have no regrets.”

Pulse of Longwood takes you inside one of the nation’s largest hubs of hospitals and biomedical research.

Leave a Comment

Please enter your name.
Please enter a comment.

  • A good opportunity to consider community-centred post death care. Next of kin have the legal and moral right (in fact, obligation) to provide after death care of their loved ones’ body as they choose.

    Community Deathcare Canada http://www.communitydeathcare.ca

  • Funeral director here. Quite often, when I get the body of someone who’s died in a hospital, it is quite apparent that nothing at all was done by the staff to “prepare the body.” I’ve received folks who died on the operating table with instruments still in place and incisions untouched; more often, all catheters and IV lines are left in.
    Look in the instrument drawer in any embalming room in the nation, and you’ll find an excess of hemostats. We hardly ever have to buy them.
    I’ve also encountered a lot of nurses and aides who seem superstitiously averse to touching a dead body, which always blows my mind — you were changing the dressing on his bedsores thirty minutes ago, but NOW he’s too icky to touch? Really?
    I take a lot of calls from families who’ve been given no information or instructions at all, regarding “what comes next.” I have to explain to them the procedure for calling the hospital’s mortuary affairs or security office. Sometimes I have to give them the phone number, because nobody at the hospital bothered to. It is infuriating, and it is far more common at hospitals which have no morgue or mortuary affairs office, and where the release of bodies to funeral homes is the responsibility of the security officers (many of whom also suffer from thanatophobia).

  • My Name is gorvina ortiz my
    Sister rose louis Charles had sadly lost her life At Brigham and Womans hospital in boston due to The hosptal being understaff
    She was 36 had three kids that depended on her her fiancée siblings and two grand kids
    My sister was still o called getting out thr bed when she took a fall then they put her back in the bed to leave her laying thier dying Instead of them rushing her down for catscan they left her bleeding while silently slipping into a coma
    Thier is
    My Question is why did no one her her fall she is in the ICU the desk is a foot from her room
    No sitter with her and thr bed alarm wad turned off
    You killed my fuckinn Sister WHYYY were was everyone so u mean to tell me not only the bed alarms was off Why was her bed rails down
    Im here to start a support group for people as myself that lost someone so dear to them due to somone else not doing thier job

Sign up for our Morning Rounds newsletter

Your daily dose of news in health and medicine.

X