Educational intervention to improve death certification at a teaching hospital

Abstract

Background: Information recorded in the 'cause of death' section of death certificates is an important source of mortality statistics. It is used for policy decisions, development of healthcare programmes and health research. Errors in death certificates can lead to inappropriate allocation of resources. Errors are universal and have been reported previously. We planned an educational intervention aimed at resident doctors from various specialties at our teaching hospital to improve the accuracy of the 'cause of death' section in death certificates.

Methods: Three workshops, each of 90 minutes, were conducted for residents. A total of 198 death certificates (96 before and 102 after intervention) were audited. We compared the frequency of major and minor errors before and after the educational Intervention.

Results: Following the educational intervention, there was a significant decrease in major errors such as unacceptable underlying cause of death (39.6% v. 24.5%, p = 0.034), reporting of mechanism without underlying cause of death (13.5% v. 1%, p = 0.001) and improper sequencing of events (25% v. 6%, p = 0.004). There was no significant decrease in minor errors such as absence of time intervals, use of abbreviations and reporting a mechanism with a legitimate cause.

Conclusion: Both major and minor errors are common in death certification at teaching hospitals. Educational interventions can improve the accuracy of reporting in death certificates.