Medical examiner service in children’s deaths: a survey of current practice in paediatric intensive care units in England and Wales

Introduction A statutory system of medical examiners (ME) was introduced in England and Wales in September 2024. The next of kin will be given the opportunity to speak to the ME and all medical certificates of cause of death (MCCDs) will require an ME countersignature. In children, there is already established guidance for a comprehensive child death review (CDR) that encompasses best operational practice with statutory requirements that must be followed. Objective and design A national survey of all paediatric intensive care units (PICUs) in England to evaluate the processes where both systems have been adopted. Results 21 of 23 (91%) PICUs responded. 75% of the surveyed PICUs have ME services established. Of these, 60% reported that the ME reviewed all deaths, including those reported to the coroner. Out-of-hours ME provision was available in only 33% of the surveyed PICUs and no review of medical notes occurred in 27% of cases. 60% of the respondents agreed ME scrutiny improved the quality of the MCCD. 40% of the respondents believed that ME review might cause delay in cultural or religious rites and the offer of organ donation. Conclusion A national ME service has potential to improve the quality of national mortality data and give voice to bereaved families’ concerns. However, in relation to children’s deaths, it needs to interface with existing statutory expectations that have similar objectives. We recommend that prospective audit be conducted to ensure both CDR and ME systems are coordinated to each other’s mutual benefit.