1
|
Pape A, Scherpelz KP. Frequency and types of errors in clinician-composed death certificates for patients with or without autopsy in a hospital population. J Public Health (Oxf) 2024; 46:83-86. [PMID: 38061768 DOI: 10.1093/pubmed/fdad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Death certificate (DC) errors are common. At our institution, all deaths have a preliminary death certificate (PDC) written by a clinician and then revised by a pathologist prior to the clinician signing the final death certificate (FDC). In autopsy cases, the FDC is signed by the pathologist who performs the autopsy. METHODS A total of 100 in-hospital deaths (50 with autopsy and 50 without) occurred in 2020 were arbitrarily selected from a tertiary care center. All PDCs and FDCs were compared to identify/classify errors as major (incorrect cause of death (COD) or significant contributing factors) or minor (abbreviations, inappropriate non-essential contributing factors, immediate/intermediate COD errors). Frequency of PDC errors was compared by autopsy status, duration of hospital stay and PDC author. RESULTS Ninety percent of cases had at least one PDC error and 39% had a major error. Major errors were more common in autopsy cases (50% versus 28%, P = 0.035), although minor/overall errors were not. Error rates did not significantly differ for the other variables assessed. CONCLUSIONS There is significance of having a pathologist review and revise DCs before they are signed. The increased frequency in major errors in cases with autopsy suggests that autopsy findings provided additional information to elucidate COD.
Collapse
Affiliation(s)
- Ariana Pape
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Kathryn P Scherpelz
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
2
|
Pinto Pastor P, Dorado Fernández E, Albarrán Juan E, Santiago-Sáez A. Quality analysis of the completion of death certificates in Madrid. Forensic Sci Int 2023; 343:111568. [PMID: 36682240 DOI: 10.1016/j.forsciint.2023.111568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
The Death Certificate (DC) is an important medical-legal. However, despite its importance, the professionals involved are not well trained and consequently there exist many errors in completion. This situation can cause misclassification in mortality statistics, but also it means that many natural deaths end up being studied by the medical examiner, entailing a waste of resources. An analysis of 1974 DCs in Madrid is carried out to assess the quality of the completion, discover the main errors in the certificates and analyse possible improvement strategies. The study highlights that the demographic and personal information about the deceased is mostly correct; in 16,2 % of the cases the official document was not used; 91 % of the DCs in the sample have a certain degree of error (major or minor); and 38,4 % of the documents chain of causes were incorrect. The main measure proposed is increased training for certifiers, which should begin with activities at undergraduate level and continue later with periodic training workshops. In addition, we consider it essential to digitalise DCs in Spain. This would greatly facilitate completion. It is also proposed that medical examiners use, in Spain, a document similar to the official DC so that the statistics of violent and natural deaths which have required the medical examiners' intervention will improve.
Collapse
Affiliation(s)
- Pilar Pinto Pastor
- Universidad Complutense de Madrid: Legal Medicine, Psychiatry and Pathology Department, School of Medicine, Pza. Ramón y Cajal, s/n, 28040, Madrid, Spain; Forensic Medicine, Medico-Legal Institute of Madrid, C/ de Julio Cano Lasso, 4, 28042, Madrid, Spain.
| | - Enrique Dorado Fernández
- Universidad Complutense de Madrid: Legal Medicine, Psychiatry and Pathology Department, School of Medicine, Pza. Ramón y Cajal, s/n, 28040, Madrid, Spain; Forensic Medicine, Medico-Legal Institute of Madrid, C/ de Julio Cano Lasso, 4, 28042, Madrid, Spain.
| | - Elena Albarrán Juan
- Universidad Complutense de Madrid: Legal Medicine, Psychiatry and Pathology Department, School of Medicine, Pza. Ramón y Cajal, s/n, 28040, Madrid, Spain; Primary Care Medicine, C/ de Alonso Cano, 8, Móstoles, 28933 Madrid, Spain.
| | - Andrés Santiago-Sáez
- Universidad Complutense de Madrid: Legal Medicine, Psychiatry and Pathology Department, School of Medicine, Pza. Ramón y Cajal, s/n, 28040, Madrid, Spain; Clínico San Carlos Hospital (In-Hospital Legal Medicine Service), Calle del Prof Martín Lagos, S/N, 28040, Madrid, Spain.
| |
Collapse
|
3
|
Rimmer MP, Henderson I, Parry-Smith W, Raglan O, Tamblyn J, Heazell AEP, Higgins LE. Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK. Int J Epidemiol 2022; 52:295-308. [PMID: 35724686 PMCID: PMC9908049 DOI: 10.1093/ije/dyac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. METHODS A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. RESULTS There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70-0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24-0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3-64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2-4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1-1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1-97.1%)]. Of 540/1246 [43.3% (95% CI 40.6-46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8-25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2-40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2-38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3-27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5-22.1%)] FGR cases were originally attributed correctly. CONCLUSION This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.
Collapse
Affiliation(s)
- Michael P Rimmer
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,MRC Centre for Reproductive Health, Queens Medical Research Institute, Edinburgh BioQuarter, Edinburgh, UK
| | - Ian Henderson
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,Warwick Medical School, University of Warwick, Coventry, UK
| | - William Parry-Smith
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,Department of Obstetrics and Gynaecology, Shrewsbury and Telford NHS Trust, Apley, UK
| | - Olivia Raglan
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Trust, London, UK
| | - Jennifer Tamblyn
- United Kingdom Audit and Research Collaborative in Obstetrics and Gynaecology, UK,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK,Department of Reproductive Medicine, Seacroft Hospital, Leeds, UK
| | | | - Lucy E Higgins
- Corresponding author. Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK. E-mail:
| | | |
Collapse
|
4
|
CDC's Efforts to Quantify Prescription Opioid Overdose Deaths Fall Short. Pain Ther 2021; 10:25-38. [PMID: 33761120 PMCID: PMC7987740 DOI: 10.1007/s40122-021-00254-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/06/2021] [Indexed: 11/04/2022] Open
Abstract
In a 2018 report titled, Quantifying the Epidemic of Prescription Opioid Overdose Deaths, four senior analysts of the Centers for Disease Control and Prevention (CDC), including the head of the Epidemiology and Surveillance Branch, acknowledged for the first time that the number of prescription opioid overdose deaths reported by the CDC in 2016 was erroneous. The error, they said, was caused by miscoding deaths involving illicitly manufactured fentanyl (IMF) as deaths involving prescribed fentanyl. To understand what caused this error, the authors examined the CDC’s methodology for compiling drug-related mortality data, beginning with the source data obtained from approximately 2.8 million death certificates received each year from state vital statistics registrars. Systemic problems often begin outside the CDC, with a surprisingly high rate of errors and omissions in the source data. Using the CDC’s explanation for what caused the error, the authors show why an international program used by the CDC for reporting mortality is ill-suited for compiling and reporting drug overdose deaths. Except for heroin, methadone, and opium, each of which has an individual program code, all other opioids are separated in just two program codes according to whether they are synthetic or semisynthetic/opiates. Methadone-involved deaths pose a special problem for the CDC because methadone has dual indications for treating pain and for treating opioid use disorder (OUD). In 2019, more than seven times more methadone was administered or dispensed for OUD treatment than was prescribed for pain, yet all methadone-involved deaths are coded by the CDC as involving the prescribed form of the drug. The authors conclude that the CDC was at fault for failing to recognize and correct this problem before 2016. Public policy consequences of this failure are briefly mentioned.
Collapse
|