Optimum standardization of cause-of-death certification procedures in healthcare facilities: A medicolegal initiative

Abstract

Medical Certification of Cause of Death (MCCD) is a document with great medical, legal, and social significance. International organizations and literature are concerned with correct MCCD writing, whereas clinical certainty regarding the cause of death gained less attention. In the last ten years, 32 studies from 21 countries reported error percentages in MCCD ranging from 20 % to 100 %. 21 out of 32 studies reported an error percentage > 90 %. Valid MCCD results from successful procedures that end with completing the death certificate form. Thus, any defect in the death management process yields an inaccurate MCCD. Therefore, the current research has in-depth looks at the radical reasons for incorrect MCCD; Egypt was selected as a country that reported a 100 % error percentage in MCCD. A focus group study was conducted through planned interviews and interactive workshops with MCCD providers until thematic saturation. All potential causes of incorrect MCCD were analyzed using root cause analysis (RCA) to explore improvement opportunities. A fishbone diagram was implemented to categorize causes of incorrect MCCD into personnel, procedures, measurements, materials, equipment, and environmental causes. Also, this research adopted a best practice approach for optimum death management resulting in error-free MCCD. The six-step approach consists of death confirmation, along with positive identification, communication with accompanying persons/relatives, postmortem examination, communication with legal authority, reporting of death, and finally, filling MCCD. This medicolegal initiative adopts quality tools to improve MCCD. Every healthcare system could benefit from this research to achieve error-free MCCD.