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Process Overview

Process Overview

The following interactive process timeline gives an overview of how all professionals are involved in a SUDI, to aid individuals in understanding why other agencies are involved, and when they may interact. You may click on your own profession to highlight your interactions with others at any given time in the process.

Example SUDI timeline showing planned feedback points for professionals to inform parents

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SUDI occurs

0-4 hours at the scene

Response to Emergency Call »

SAS and police attend in response. In remote & rural areas GP/ HV may be first called.
1. Continue/ Initiate CPR »
  
  In the majority of cases CPR will be initiated/continued and the infant transferred to the nearest paediatric Emergency Department by the SAS. Download UK Resuscitation guidelines paediatric (advanced) or UK Resuscitation guidelines paediatric (basic)
2. Note any attempted CPR by parent(s)/ carer(s) »
  
  This note should record what was initiated, when it began and any response from the infant. It provides a background for Emergency Department consultants to assess response to resuscitation.
3. Note circumstantial observations »
  
  This note should record the circumstances that the infant was found in:
  e.g. where sleeping,
  what sleep surface,
  if co-sleeping,
  bedding used,
  temperature of the room,
  information about home environment
  This list is not exhaustive.
4. Ensure safety of other children »
  
  Call on the help of a neighbour, friend or relative to look after other children whilst the parents go to hospital with the infant.
5. Support family with initial explanation »
  
  Explain the of the role of the police and the need to transfer the infant to an Emergency Department, even if the infant appears to have died some time earlier during sleep. The infant will be examined by a paediatrician and the staff in the Emergency Department can provide support and further explanation on what happens next.
6. Inform Emergency Department of expected arrival »
  
  Provides Emergency Department staff with a brief on the situation and allows them to prepare for the infant and family.
  1. SAS hand over to Emergency Department staff
In remote and rural settings GP or HV may first attend »

GP to liaise with SAS and police about transfer of the infant, may transfer infant themselves, though not usually.
1. GP/HV hand over to Emergency Department staff
Police request a supervisory officer to the scene »

A Detective Inspector, Senior Investigating Officer (SIO) will be appointed to the case and the SIO will control the scene to ensure that any evidence which might help explain what has happened can be collected (Items such as bedding, bottle feeds made up, and soft toys in the bed beside the infant may all be removed for testing).

0-4 hours At the Emergency Department

Ahead of infant arrival »

On notification from SAS, police, or GP/HV in remote and rural areas.
1. Access SUDI pack »
  
  Ensure items required are at hand, also includes assigning roles to team, in particular define parent supporter.
2. Contact Paed'n (SUDI paed'n if available)
On infant's arrival at the Emergency Department
1. Continue any CPR »
  
  Any appropriate samples are also to be taken.
2. Parents supported by ED staff »
  
  Explanation of what is happening during resuscitation is given. A quiet room must be made available for the parent(s)/ carer(s). Some parents will want to be present during the attempted resuscitation, others will not want to see what is happening but will need to be informed of progress.
Infant declared dead if no response after 20 minutes full CPR »

Or also pronounced dead if any of the following apply:
Senior doctor assesses infant has been dead for some time
Ambulance team report no response to CPR for >20 minutes
Rigor mortis is present.
1. Retain samples already taken. Take no further samples »
  
  Samples already collected must be marked with "Freeze and Keep". No further samples to be taken as samples taken after life pronounced extinct mortem may confuse pathologist’s findings at post mortem.
  1. Certain additional samples can be taken for in hospital SUDI/ SUPC of the newborn »
    
    Additional samples may be taken only after discussion with a pathologist.
2. Emergency Department consultant and nurse to inform parents of infant's death
  1. Neonatologist and nurse to inform parents of infant's death
3. Contact police if not already present »
  
  Police would normally attend the scene as usually notified through ambulance control. The contact from the Emergency Department may however be first notification of police. Uniformed officers should be sensitive to situation and enter department without wearing fluorescent jackets and have police radios switched off. Where possible plain clothes officers should be utilised if aware of situation before attending.
4. Child protection register to be checked
  1. Contact social work if applicable »
    
    An initial check should inform staff of any potential child protection issues and provide useful background information prior to gathering further information from staff and parents. As well as providing background information, early social work support involvement for parents being supported by social services may be of benefit.
  2. Inform local child protection advisor »
    
    Any information to be shared between healthcare and police.
Initial Parent Support
1. Emergency medicine consultant to provide initial parent support »
  
  The sequence of events re police, procurator fiscal notification, and the need for a post mortem must be clearly explained. If paediatrician or SUDI paediatrician is in the department it should be agreed locally if they will take on this role from the outset.
  1. Parent(s)/ Carer(s) given time with their son/ daughter »
    
    Parents should be allowed as much time to say goodbye to their son/ daughter as they need, before the infant is transferred to the mortuary. They should be encouraged to hold the infant, under supervision, if appropriate. It should be explained who they should contact to arrange to see their infant again at the mortuary, if they wish this.
  2. Police (if present) and healthcare professionals to sensitively gather information »
    
    Police (if present) and identified healthcare worker to ask questions in order to gather background information for the PF and the pathologist. The History and Examination form should be completed by health professionals. Police ask relevant questions in order to complete their Sudden Death report.
  3. Parents receive information »
    
    The parents must be given a clear explanation about the procedures that will follow and also be given the information in written format to read over later. They must also receive information on local bereavement support and details of support organisations available. Parents must be given written information with the name and contact number of the person who will be following up the investigations and offer support, and also when they can expect to hear from that person.
Examination of the infant »

Paediatrician/SUDI paediatrician or emergency medicine consultant to examine the infant and complete the necessary parts of the History and Examination form to provide information for the police in submitting their sudden death report to the Procurator Fiscal. This may happen before the discussion with the parents depending on individual circumstances.

The next 24 hours post SUDI

Emergency Department notifications »

Emergency Department consultant to make contact with GP, social worker, if involved with family, and also the SUDI paediatrician to ensure they are aware of case
1. GP to inform other relevant staff in primary care team »
  
  GP to inform health visitor or equivalent, community midwife, community nurse manager as relevant
2. Neonatologist to inform relevant staff »
  
  In the case of in hospital SUDI/ SUPC, the neonatologist would undertake the role of informing staff such as the obstetrician, midwives, nursing team, GP, community midwife, health visitor
Police sudden death report to Procurator Fiscal next (lawful) day »

In most cases the police will already be aware of the SUDI and will submit a report. If they are not involved from the start the Procurator Fiscal will instruct them to submit the report.
Identified* paediatrician clarifies parent information given in Emergency Department. »

*Paediatrician involved with family from start (may not be SUDI paediatrician). The information in the Emergency Department SUDI pack includes the parent bereavement leaflets, SUDI parent information leaflet, and contact numbers for the named paediatrician who will provide support and discuss the post-mortem examination findings, including a contact number for the paediatrician. If necessary make contact with parents and explain again the need for a post-mortem examination and the provisional result that will follow
Within 14 days post SUDI

Procurator Fiscal investigation
1. History and Examination report according to local procedures. »
  
  Completed in the Emergency Department with parents, some questions may need to be followed up with staff/health visitor/GP once parents have left
2. Procurator Fiscal instructs a post-mortem examination »
  
  Will be performed by a paediatric pathologist, police will be informed by Procurator Fiscal if they are required to be present
3. Area Procurator Fiscal notifies SUDI paediatrician »
  
  The SUDI paediatrician may not be directly following up the case if not involved from the start but will have an overseeing role in all cases in their health board
  1. SUDI paediatrician contacts Procurator Fiscal »
    
    A letter/email is sent requesting a copy of the post-mortem examination results
4. »
  1. »
5. Area Procurator Fiscal informs parents of SUDI review meeting »
  
  Also informs parents that the NHS board will be co-ordinating the meeting. The Procurator Fiscal also reiterates the support provided by identified paediatrician
  1. 1. SCDT offers support to family »
      
      Contact is made via a letter offering support
Paediatric pathology instructed by Procurator Fiscal to perform a post-mortem examination
1. Paediatric pathologist & identified paediatrician* have dialogue before post-mortem examination »
  
  This discussion ensures that the paediatric pathologist has the required background information surrounding the circumstances of the SUDI and is aware of investigations performed in the Emergency Department
2. Initial post-mortem report to the Procurator Fiscal »
  
  Preliminary result, final report awaits results from samples taken
3. Paediatric pathologist notify Healthcare Improvement Scotland via card return »
  
  Card return notifications to be placed in each paediatric pathology department so that Healthcare improvement Scotland can be informed via section of card returned after each post-mortem carried out for SUDI. The section which the pathology department keep acts as a prompt to keep the case notes to hand for future SUDI review meeting.
  1. Healthcare Improvement Scotland contacts SUDI paediatrician »
    
    This step is done via email followed up with a letter containing infant's details. This ensures that the SUDI paediatrician is aware of the case if the ED or PF have failed to make contact. The SUDI paediatrician may identify another paediatrician(if not themselves) to follow up the case including attending a possible SUDI review meeting.
4. Pathologist & identified paediatrician to have dialogue after post-mortem examination »
  
  This is done prior to the 1-2 week parent meeting to enquire if any likely delays in the final report being issued, due to scheduled leave etc.
Follow up parent meetings
1. 1-2 weeks post SUDI
  
  Parent meeting »
  
  Meeting between parents & identified paediatrician & perhaps paediatric pathologist to explain initial post-mortem examinationfindings and ongoing tests. Explain the SUDI review meeting again if appropriate after post-mortem findings. Medical causes of death diagnosed at initial post-mortem may not require SUDI review if no others factors present which may require additional support for parents.
2. 6-8 weeks post SUDI
  
  Contact made with parents at 6-8 weeks »
  
  Identified paediatrician to contact family to reassure that the final post-mortem result will be available as soon as all further pathology investigations are completed.
16+ weeks post SUDI

Final post-mortem examination report available »

Results from samples may take several weeks, in particular neuropathology. Once these results are available, a final post mortem report will be issued by the paediatric pathologist assigned to the case
1. Final post-mortem report to Procurator Fiscal »
  
  The final report will be sent to the Procurator Fiscal by the pathologist.
  1. Copy of post-mortem report sent to SUDI paediatrician »
    
    The area Procurator Fiscal will forward on a copy of the final post-mortem report to the SUDI paediatrician who will ensure identified paediatrician (if not themselves) is aware of the final report.
  2. Copy of post-mortem report sent to GP »
    
    The area PF will forward on a copy of the final post-mortem report to the GP if it has been requested.
2. Procurator Fiscal informs Healthcare Improvement Scotland that a SUDI review has been authorised. »
  
  Area Procurator Fiscal informs Healthcare Improvement Scotland that a SUDI review has been authorised, using card returns which are completed within the Fatality Investigation offices.
3. SUDI review not authorised »
  
  In any cases where Significant Case review or fatal accident enquiry or prosecution taking place.
SUDI review meeting

Healthcare Improvement Scotland notifies NHS Board that they are authorised to proceed to SUDI review meeting »

With SUDI paediatrician or named paediatrician (if involved with family from start) &/or GP depending on local arrangement for the case.
1. Healthcare Improvement Scotland contacts professionals involved: »
  
  Identified paediatrician, paediatric pathologist, GP, health visitor or equivalent, community midwife, social worker. Also consider contacting the community nurse manager. In the case of an in hospital SUDI or SUPC where the infant subsequently dies the professionals involved may be the obstetrician, midwife and the nursing team. Contact is made to arrange a suitable time to meet for all those involved.
2. Healthcare Improvement Scotland complete abstraction form »
  
  Healthcare Improvement Scotland complete a data form abstracted from all available information to provide a multi disciplinary summary prior to the meeting. This should be made available to both the paediatric pathologist and the identified paediatrician.
3. SUDI review meeting arranged »
  
  SUDI review multi disciplinary meeting arranged to take place by six weeks after final post-mortem report is available. This time lag should allow professionals involved to arrange adequate cover to allow them to attend the meeting.
  1. SUDI review meeting »
    
    In either hospital with SUDI paediatrician or named paediatrician (if involved with family from start) arranging a meeting room, or in GP surgery meeting room, depending on local agreement. For the in-hospital SUDI/ SUPC the meeting would most likely take place in the hospital but shall be agreed locally.
  2. SUDI review summary sheet completed at the meeting »
    
    Agreement from all on final cause of death and any factors that need to be considered. Any identified additional support for the family are agreed as are the action plan to implement this support.
  3. 1-2 weeks post SUDI review meeting
    
    Outcome of SUDI review summary sheet added to:
    Mother's Primary Care records
    Father's Primary Care records
    Maternity records »
    
    Ensures appropriate care of next infant and that support is available when required at future appointments.
Meeting with family to discuss outcome of SUDI review »

Identified paediatrician and sometimes the pathologist should meet with the parents to feedback on the outcome of the SUDI Review meeting, in particular informing them of any additional support needs identified. The GP may also be part of this meeting as per local agreement. In particular care of next infant should be discussed and the additional support that will be available, such as the loan of an apnoea monitor.
1. Parent notification of records held »
  
  The identified paediatrician or GP (agreed locally) should inform the parents where the outcome summary of the SUDI review meeting.