In-Custody Death Reviews
In-Custody Death Reviews
Every in-custody death warrants a thorough, objective review to identify contributing factors, evaluate systems and processes, and strengthen patient safety. NCCHC Resources provides independent, evidence-based in-custody death reviews for correctional agencies, health care providers, and government oversight entities. Our multidisciplinary team helps determine root causes, identify systems and individual errors, and recommend practical corrective actions that support continuous quality improvement.
Our reviews include:
- Comprehensive medical record review
- Emergency department and coroner report review
- Evaluation of facility policies and procedures
- Physician-led clinical chart review
- On-site facility assessment
- Interviews with medical and custody staff
- Surveillance video review, when applicable
- Assessment of emergency response and man-down procedures
- Root cause analysis of clinical and operational factors
- A detailed written report with actionable recommendations based on NCCHC Standards
Our recommendations help facilities:
- Strengthen emergency preparedness and equipment readiness
- Improve medication administration and diversion prevention practices
- Enhance intake screening and assessment processes
- Reinforce collaboration between custody and health care staff
- Identify systemwide opportunities for quality improvement
- Reduce risk through practical, evidence-based corrective actions
Whether supporting a single investigation or conducting recurring systemwide reviews, NCCHC Resources provides the independent expertise organizations need to improve care, strengthen accountability, and build safer correctional health care systems.
Learn how NCCHC Resources can help your organization conduct independent in-custody death reviews that drive meaningful quality improvement and support safer correctional health care.
For more information, request a meeting or contact us by phone or email.