Impact of an educational intervention on errors in death certification: An observational study from the intensive care unit of a tertiary care teaching hospital

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Abstract

Background:

A high incidence of errors occur while filling up death certificates in hospitals. The purpose of this study was to analyze the impact of an educational intervention on errors in death certification in an intensive care unit (ICU). Patients admitted to ICUs by virtue of being critically ill have a higher mortality than other hospitalized patients. This study was designed to see if any improvement could be brought about in filling death certificates.

Materials and Methods:

Educating sessions, interactive workshops, and monthly audits for the department resident doctors were conducted. One hundred and fifty death certificates were audited for major and minor errors (75 before and 75 after the educational intervention) over a period of 18 months. Fisher's exact test was applied to statistically analyze the data.

Results:

There was a significant decrease in major errors like mechanism without underlying cause of death (60.0 vs. 14.6%, P < 0.001), competing causes (88.0 vs. 13.3%, P < 0.001), and improper sequencing (89.3 vs. 36.0%, P < 0.001). There was also a significant decrease in minor errors such as use of abbreviations (89.3 vs. 29.3%, P < 0.001) and no time intervals (100.0 vs. 22.6%, P < 0.001).

Conclusion:

Authors conclude that death certification errors can be significantly reduced by educational interventional programs.

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Most cited references 18

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Improving the accuracy of death certification.

Jason Farquhar, Linda K Myers (1998)

Population-based mortality statistics are derived from the information recorded on death certificates. This information is used for many important purposes, such as the development of public health programs and the allocation of health care resources. Although most physicians are confronted with the task of completing death certificates, many do not receive adequate training in this skill. Resulting inaccuracies in information undermine the quality of the data derived from death certificates. An educational intervention was designed and implemented to improve internal medicine residents' accuracy in death certificate completion. A total of 229 death certificates (146 completed before and 83 completed after the intervention) were audited for major and minor errors, and the rates of errors before and after the intervention were compared. Major errors were identified on 32.9% of the death certificates completed before the intervention, a rate comparable to previously reported rates for internal medicine services in teaching hospitals. Following the intervention the major error rate decreased to 15.7% (p = 0.01). The reduction in the major error rate was accounted for by significant reductions in the rate of listing of mechanism of death without a legitimate underlying cause of death (15.8% v. 4.8%) (p = 0.01) and the rate of improper sequencing of death certificate information (15.8% v. 6.0%) (p = 0.03). Errors are common in the completion of death certificates in the inpatient teaching hospital setting. The accuracy of death certification can be improved with the implementation of a simple educational intervention.

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Teaching cause-of-death certification: lessons from international experience.

Eindra Aung, Chalapati Rao, Sue Walker (2010)

The accuracy of cause-of-death statistics substantially depends on the quality of cause-of-death information in death certificates, primarily completed by medical doctors. Deficiencies in cause-of-death certification have been observed across the world, and over time. Despite educational interventions targeted at improving the quality of death certification, their intended impacts are rarely evaluated. This review aims to provide empirical evidence that could guide the modification of existing educational programmes, or the development of new interventions, which are necessary to improve the capacity of certifiers as well as the quality of cause-of-death certification, and thereby, the quality of mortality statistics. A literature review using keywords: death; certification; education/training. The primary search through PubMed. Reference lists in individual articles from the primary search and also manual searching of other databases such as Google Scholar and OpenDOAR. Evaluation studies which assessed educational interventions for medical students and doctors on correct completion of death certificates. All educational interventions identified in this review improved certain aspects of death certification although the statistical significance of evaluation results varies with the type of intervention: printed educational material alone being the intervention with the least educational impact and interactive workshops being the most effective intervention. Pragmatic education on best practice for cause-of-death certification is a basic step to ensure accurate information for each individual case, leading to the production of high quality mortality statistics for epidemiology, public health policy and research. Development of new educational interventions or modification of existing programmes should be based on evidence of the benefits from current and past interventions provided under varying circumstances.

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Death certification errors at an academic institution.

Nina Shapiro, Stewart Richmond, Sarah Hardin … (2005)

The correctly completed death certificate provides invaluable personal, epidemiologic, and legal information and should be thorough and accurate. Death certification errors are common and range from minor to severe. To determine the frequency and type of errors by nonpathologist physicians at a university-affiliated medical center. Fifty random patients were identified who died at this academic medical center between January 2002 and December 2003 and did not undergo an autopsy. From medical chart review, clinical summaries were produced. Two pathologists used these summaries to create mock death certificates. The original and mock death certificates were then compared to identify errors in the original certificate. Errors were graded on a I to IV scale, with grade IV being the most severe. Of the 50 death certificates reviewed, grade I, II, and III errors were noted in 72%, 32%, and 30%, respectively. Seventeen certificates (34%) had grade IV errors (wrong cause or manner of death). Multiple errors were identified in 82% of the death certificates reviewed. The rate of major (grade IV) death certification errors at this academic setting is high and is consistent with major error rates reported by other academic institutions. We attribute errors to house staff inexperience, fatigue, time constraints, unfamiliarity with the deceased, and perceived lack of importance of the death certificate. To counter these factors, we recommend a multifaceted approach, including an annual course in death certification and discussion of the death certificate for each deceased patient during physician rounds. These measures should result in increased accuracy of this important document.

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Author and article information

Journal

Journal ID (nlm-ta): J Anaesthesiol Clin Pharmacol

Journal ID (iso-abbrev): J Anaesthesiol Clin Pharmacol

Journal ID (publisher-id): JOACP

Title: Journal of Anaesthesiology, Clinical Pharmacology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0970-9185

ISSN (Electronic): 2231-2730

Publication date (Print): Jan-Mar 2014

Volume: 30

Issue: 1

Pages: 78-81

Affiliations

[1]Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Author notes

Address for correspondence: Dr. Afzal Azim, Department of Critical Care Medicine, Lucknow - 226 014, Uttar Pradesh, India. E-mail: draazim2002@ 123456gmail.com , afzala@ 123456sgpgi.ac.in

Article

Publisher ID: JOACP-30-78

DOI: 10.4103/0970-9185.125708

PMC ID: 3927298

PubMed ID: 24574598

SO-VID: b87970f1-7051-4e0d-a8d1-a6ae47f48601

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Impact of an educational intervention on errors in death certification: An observational study from the intensive care unit of a tertiary care teaching hospital

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Abstract

Background:

Materials and Methods:

Results:

Conclusion:

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Irish Journal of Paramedicine

Most cited references 18

Improving the accuracy of death certification.

Teaching cause-of-death certification: lessons from international experience.

Death certification errors at an academic institution.

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