Surveyors use death records to evaluate culture, communication, and learning

Death record tracers can feel intimidating because they carry emotional weight and legal sensitivity, and they often expose process problems that were tolerated when the patient was alive.

“During a Joint Commission survey, death records are frequently requested for tracers, leadership interviews, and data-driven reviews,” says Gayle Nash, MPH, RN, president and CEO of Nash Healthcare Consulting.

She emphasizes that death record review becomes a lens into patient rights, family involvement, escalation processes, and whether the hospital consistently reviews and learns from patient deaths.

“As with all medical record reviews, I always look for (1) the patient's story, (2) transitions of care reflected in the care plan, and (3) how communication was carried out between the patient, provider, and the nursing staff,” she says.

Nash walks leaders through a structured review process that can be turned into an internal tool:

• High-level overview: identifiers, admission, death details, provider of record, diagnoses
• Pronouncement and death documentation: time of death, pronouncer, criteria, alignment between nursing/provider notes, family notification
• Care prior to death: trends, response to deterioration, timeliness of provider notification, rapid response use, reassessment
• Code events or end-of-life decisions: code documentation completeness and timestamps; alignment of directives/orders with care provided; goals-of-care documentation
• Required notifications and reporting: attending, coroner/medical examiner when applicable, organ donation referral, risk management for unexpected deaths, committee reporting
• Medical record completion: death summary/discharge note, final diagnoses/cause of death, authentication, completion of reports
• Mortality review and PI: review per policy, expected vs. unexpected, peer/case review, improvement opportunities, action tracking
• Consistency across the record: timelines align, policies current and followed, no unexplained gaps

“When you are looking at a death record, ensure you allocate plenty of time to review the care from the day of admission through the time of death and beyond,” says Nash, speaking from her experience as a nurse expert witness.

Editor’s note: This article was excerpted from our Inside Accreditation & Quality newsletter.