Taking a Baby, Child or Young Person from Hospital after Death - Standard Operating Procedure for

Publication: 01/08/2004  --
Last review: 09/03/2020  
Next review: 06/03/2023  
Standard Operating Procedure
CURRENT 
ID: 538 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Standard Operating Procedure for taking a Baby, Child or Young Person from Hospital after Death

Aims

  • To standardise and optimise the practice to be followed when supporting a family to take a child from the hospital after death.

Back to top

Background and indications for standard operating procedure/protocol

The death of a child or young person in hospital is a distressing event for the health care team caring for the child and family. Care after death is difficult, and the choices available to families are restricted by regulations intended to support safe practice.

In some circumstances the family may ask to take the child direct to the family home, to a local children’s hospice or to the local Funeral Director’s parlour following death, without going to the mortuary. This SOP is intended for use in the Leeds Children’s Hospital to ensure that safe practice is followed after death in all cases. If the child leaves the hospital directly from the clinical area, and does not go via the Mortuary, the clinical team take full responsibility for the release of the body.

Back to top

Procedure method (step by step)

Children and young people who die in hospital will be taken to the mortuary in line with the LTHT Bereavement Policy. This should be presented to the family as accepted practice, and the family should be given full support in this process. Where a death has been registered, a Funeral Director can collect the body immediately following transfer to the mortuary if that is the wish of the family. In this way all mortuary procedures may be followed in and out of hours.

In some cases the family may need support in contacting a Funeral Director, all of whom have a 24 hour service. If families require help in identifying a Funeral Director the Trust has a contract with a company who offer a 24 hour service: (Telephone:  0113 245 0507). If the family asks to take the child direct to the family home, to a local children’s hospice or to the local Funeral Director’s parlour following death, without going to the mortuary, the procedure set out below should be followed.

Coroner's Cases
A body must not be released to the family in a Coroner's case other than in exceptional circumstances; see “Exceptional release of a body in a Coroner’s case”.

If any staff member has any doubt as to whether this is a Coroner's case the body must not be released and this must be documented in the notes.

Hospital Post Mortem
The child's consultant will determine the need for a hospital post mortem and ensure that consent is gained from the parents using the appropriate consent forms (see LTHT Bereavement Policy and ‘Hospital Post Mortem Procedure’ document for further guidance).

Infection Control
If a child who has died was known to have a notifiable infectious disease, the advice of the Consultant in Communicable Disease Control, (CDDC), or their deputy must be sought before releasing the body to the family. Standard infection prevention measures should be followed when caring for a child after death.

Taking a Child from Hospital to Home following registration of a death
A medical certificate of cause of death (MCCD) must be issued by the doctor certifying the cause of death to the next of kin. The body must never be released without an MCCD. Death certificate books are held on the Paediatric Intensive Care Unit, the Neonatal Unit, and on the children’s cancer ward (L31).

The next of kin or nominated other (usually another relative of the child) should be advised and supported within working hours to register the death with the Registrar in Leeds who will issue a green 'certificate of disposal'. An appointment must always be made to register the death.

The Contact Centre is open to make appointments between 9am and 5pm Monday to Friday. Telephone number: 0113 2224408.

The Registrar’s office opening times are: Mon, Tue, Thu, Fri 8:45am to 4:45pm; Wed 9:45am to 4:45pm and Saturday 9am to 12pm

The Registrar’s office is close to the LGI - at Merrion House on Merrion Way.
There are other local registrar offices in Leeds, with varying opening hours. Full details of opening hours and contact points can be found on the local authority web pages at: https://www.leeds.gov.uk/residents/births-deaths-and-marriages/death
 
By approaching the family with sensitivity, it will usually be possible for the child to be taken via the Mortuary, for collection by a Funeral Director, and in this way all the Mortuary procedures may be followed without the child staying in the Mortuary if that is what the family wishes.

If the family are determined that the child will not go via the Mortuary it is the responsibility of the clinical team to ensure that all processes outlined in this document are completed. They should make arrangements for the Funeral Director to come to the clinical area, and collect the child, on production of the green ‘Disposal form’. The Mortuary staff should be contacted in working hours to inform them of the case. Out of hours, the Clinical Site Matron should be contacted, and an LTHT Mortuary ‘Body Release form’ (Appendix 1) must be completed by the Clinical Site Matron and the Funeral Director who collects the child from the clinical area. The duty Clinical Site Matron will take responsibility for ensuring the completed body release form is added to the ‘out of hours’ folder in the Mortuary.

Taking a Child from Hospital to Home prior to registration of a death
There may be occasions when deaths occur outside ‘working hours’ and families have a strong wish to either take a child home, to a local Funeral Directors, to a local children’s hospice , before the death can be registered.

In this situation the child’s Consultant, or out of hours the Consultant covering the service may authorise the ‘release’ of the body prior to registration, documenting their consent to this release in the clinical notes. The death will still need to be registered, but this will allow the Funeral Director to collect the body from the hospital for transport home, to a local hospice, or to the Funeral Directors. Only a Consultant can authorise this procedure.

A medical certificate of cause of death (MCCD) must be issued by the doctor certifying the cause of death to the next of kin. The body must not be released without an MCCD. A member of medical staff should complete an MCCD, the counterfoil and a notice to informant (this is part of the MCCD).  Only a doctor who has treated the patient in life in the previous 14 days may issue the MCCD, and this should usually be done by, or in close consultation with, a Consultant Paediatrician or Critical Care Consultant. Should medical staff have any doubt regarding the cause of death or require the advice of the Coroner before completing an MCCD, contact should be made with the main police switchboard (Tel:101) who will provide the necessary information regarding contact with the on-call Coroner’s Officer.

Following completion, the MCCD should be placed in a sealed envelope addressed to the Registrar and the notice to informant should be attached to the outside of the envelope. It is good practice to discuss the stated cause(s) of death with the family and informants.  This should then be handed to the next of kin.

An ‘Authorisation of Release’ form must be completed by the relevant consultant, and signed by the nurse in charge of the clinical area where the child has died (Appendix 2). It will be signed by the person collecting the body, usually a Funeral Director, from the clinical area. The original form will be kept by the Funeral Director, a copy will go to the Mortuary, and a copy will be filed in the medical notes.

Following local completion of the ‘Authorisation for Release’ form, an LTHT Mortuary ‘Body Release form’ (Appendix 1) must be completed by the Clinical Site Matron and the Funeral Director. The duty Clinical Site Matron will take responsibility for ensuring the completed body release form, and copy of the authorisation form is added to the ‘out of hours’ folder in Mortuary.

If a death occurs at a weekend or over a Bank Holiday, and there is a religious requirement for a funeral to take place before the death is registered, Jewish and Muslim families should be supported to make contact with a designated individual acting on behalf of their faith community for advice on obtaining a green ‘Disposal’ Form’ to facilitate a funeral. This enables the family’s funeral director to perform the funeral; it does not mean the death is registered. The family should be advised that they would still need to register the death at the Registry office after the funeral.  The faith community contacts are also available for general advice and information, for their respective communities.

Contact numbers are:

Jewish community contacts

Linda Schulman

0759 087 6416

Susan Cohen

0796 655 5517

Muslim community contact

Al Hassan Funeral Services

0113 318 7256

Transportation from the Hospital
Once the above requirements have been completed, careful consideration must be given to the preparation of the body and arrangements to transfer the body home or hospice; safely with care and dignity using the services of a Funeral Director. If families require help in identifying a Funeral Director the Trust has a contract with a firm who offer a 24 hour service (Telephone: 0113 2450507). Families should be strongly advised and counselled to use the services of a Funeral Director to take a child home.

If the family is determined to use their own transport to take the child home, they should be supported to do so in as safe, discreet and dignified way as possible. The family should always have the MCCD form with them, but there is no requirement to contact the police to inform them that a child is being taken home.

If the child is known to one of the local Children’s Hospices they may be able to assist in the transportation of the body if the family would like to use the facilities available in the hospice.

Telephone numbers:


Martin House Children’s Hospice (Boston Spa)

01937 844836

Forget Me Not Children’s Hospice (Huddersfield)

01484 411042

Bluebell Wood Children’s Hospice (Sheffield)

01909 517 360

St Andrew’s Hospice - Andy’s (Grimsby)

01472 350908

Leaving the Hospital
The family should be given as much time as they need with the child in the ward or unit. If the Funeral Director collects the child directly from the ward/unit, this needs to be arranged with sensitivity and maintain the dignity of the child, the privacy of the family and the feelings of other patients and their families.

Leaving the hospital needs to be as private and as dignified as possible. This may be through the Funeral Director’s entrance at the Mortuary on either hospital site. In working hours, this can be arranged by contacting the mortuary directly. Outside working hours contact the portering supervisor (Bleep 802433) or via Control Centre.

Follow-up Support
The family GP and any other agencies involved with the family should be informed of the death, and the fact that the child has been taken home so that local arrangements for support can be made.

The clinical area should inform the Bereavement Office of the child’s death and transport home on the next working day.

If a child is being taken to the family home a Trust information sheet, ‘Useful Information When Taking Your Child Home’ (Appendix 3), should be given to the family, along with supporting material from the clinical area. The clinical area must notify the General Practitioner of the patient's death indicating that the body was released from hospital.

Exceptional release of a body in a Coroner’s case
There are exceptional circumstances where the Coroner may authorise that a Post Mortem is not required, but the case remains subject to all other normal coronial processes.
Where the family wishes for their child not to be transferred to the mortuary, HM Coroner may authorise a transfer to a local hospice depending on the circumstances of the death (and with agreement from the hospice). Such circumstances could include road traffic collisions, accidental hanging, or drowning; circumstances  where, although the death was not from natural causes:

•          there are no suspicious circumstances
•          no post mortem is required for the police investigation
•          treating medical staff can provide a Report in Lieu of Post Mortem

In such circumstances Medical staff do not and cannot issue an MCCD for the death, as it will still need to be investigated by HM Coroner.

Written confirmation must be obtained from the Coroner’s office, authorising approval of the release from the hospital. An email/fax from the Coroner’s Officer is sufficient.

In such circumstances the body must never be released without this documented approval. Documented approval should clearly outline the following:

  • that a Post Mortem is not required
  • that approval has been given for the named child to be transferred to a clearly specified Hospice
  • that a Report in lieu of Post Mortem is required and how this should be provided to the Coroner’s Office

This documentation can then be presented to either the mortuary staff (or Clinical Site Matron Out Of Hours), to ensure a smooth release from the hospital to the hospice.
The Consultant should also document their approval and authorisation of the release and transfer on the ‘release’ form (Appendix 2) and in the Clinical Notes.

Advice should be sought from experienced nursing and medical staff in these circumstances. (Family Care Sister on PICU on Ext 26511 Mobile 07827826656 Mon-Fri 8.30-4.30; or the Children’s Haematology/Oncology Outreach team on Ext. 22323; Out of Hours via Pager 07623 987119).

Prior to arranging the transfer of the child’s body to the hospice, please advise the hospice team (and the child’s family) that any further transfer, or a funeral, cannot take place until HM Coroner has ‘opened and adjourned’ the case in court.  

Back to top

Provenance

Record: 538
Policy/Guideline number (Nursing, Midwifery and Health Visitors only) 01 11 04
Objective:

To standardise and optimise the practice to be followed when supporting a family to take a child from the hospital after death.

Clinical condition:
Target patient group:
Target professional group(s): Midwives
Secondary Care Doctors
Secondary Care Nurses
Adapted from:

N/A


Evidence base

This SOP is based on Evidence Level D:  Consensus within the Leeds Teaching Hospitals Trust

 

Evidence levels:

A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs

B. Robust experimental or observational studies

C. Expert consensus.

D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 2.0

Related information

Not supplied

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.