Abstract
BackgroundThe inaccuracy of death certification can lead to the misallocation of resources in health care programs and research. We evaluated the rate of errors in the completion of death certificates among medical residents from various specialties, before and after an educational intervention which was designed to improve the accuracy in the certification of the cause of death.MethodsA 90-min seminar was delivered to seven mixed groups of medical trainees (n = 166) from several health care institutions in Spain. Physicians were asked to read and anonymously complete a same case-scenario of death certification before and after the seminar. We compared the rates of errors and the impact of the educational intervention before and after the seminar.ResultsA total of 332 death certificates (166 completed before and 166 completed after the intervention) were audited. Death certificates were completed with errors by 71.1% of the physicians before the educational intervention. Following the seminar, the proportion of death certificates with errors decreased to 9% (p < 0.0001). The most common error in the completion of death certificates was the listing of the mechanism of death instead of the cause of death. Before the seminar, 56.8% listed respiratory or cardiac arrest as the immediate cause of death. None of the participants listed any mechanism of death after the educational intervention (p < 0.0001).ConclusionMajor errors in the completion of the correct cause of death on death certificates are common among medical residents. A simple educational intervention can dramatically improve the accuracy in the completion of death certificates by physicians.
Highlights
The inaccuracy of death certification can lead to the misallocation of resources in health care programs and research
We describe the impact of an educational intervention delivered to several groups of medical residents designed to improve the accuracy of death certification
The probability of accurately completing the death certificate after the seminar was more than three times higher than before the seminar (RR 3.67, 95%confidence intervals (CI): 2.84–4.73) and the overall rate of improvement attributable to the educational intervention was 62.1% (p < 0.0001) (Figure 2)
Summary
The inaccuracy of death certification can lead to the misallocation of resources in health care programs and research. Death certification is mainly a professional activity oriented to medico-legal purposes, the information from death certificates is used for epidemiological purposes to monitor the health status of a population and direct the allocation of health care resources for health care programs and research [4,5,6]. The standard death certificate in Europe follows the recommendations of the World Health Organization which recommends that the underlying cause of death should be used for statistical analysis of mortality [3]. BMC Health Services Research 2007, 7:183 http://www.biomedcentral.com/1472-6963/7/183 fessional activity and the process is well standardized, a critical review of the information contained in death certificates shows that they are full of errors [7]. Correct certification of the cause of death requires: 1) awareness of the distinction between "cause" and "mechanism" of death, and 2) understanding the meaning of the concepts "immediate cause of death" and "underlying cause of death", both of them included in the standard format of the medical section of a death certificate
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