Quality of death certificate records in a reference public hospital

Montevideo, Uruguay, October-November 2009

Abstract

Introduction: death certificates are the main instrument of the mortality information system. Its efficiency depends on adequate entries and correct information.
Objectives: to learn about the quality of information registered in death certificates at the Maciel Hospital (October and November 2009); to identify weaknesses in registration; to quantify mistakes and determine whether they can be corrected or not; to learn about the observance of relevant legislation in force, regarding registrations.
Method: retrospective, comparative, descriptive observational study based on death certificates audits and its correlation with medical records. Each case was analyzed by a multidisciplinary committee. Three categories were defined: I. Correct and complete record; II. Partially correct or complete record, or both; III. Incorrect record.
Results: out of 154 patients at the Maciel Hospital, 92% (n=142) of the death certificates were issued by doctors belonging to the hospital. Out of the 12 corpses referred to the Court Morgue, in 9 cases the decision was justified (75%). 12,87% (n=18) corresponded to category I; 53,53% (n=76) to category II, and 28,73% (n=41) to category III. Most surgeries (69,53%) that had some connection with the process resulting in the patient's death were not registered.
Discussion: the mistakes identified were also reported in the international bibliography. The fact that a) only 12,87% of the causes of death was correct; b)53,52% was incorrect or incomplete(it could be corrected through a new classification) and c),in 28,73% the cause of death was mistakenly allocated without there being a chance to correct it with no audit of medical records, is meaningful. International experience evidences the importance of carrying out death certificates validation systematic studies, as well as of the impact on improvement of registrations certain simple educational interventions for medical doctors have.
Conclusions: the study enabled the identification of obvious inconsistencies between the information registered in the death certificates examined and the medical records. Irreparable mistakes in the allocation of the cause of death (without auditing the entire medical record) reached 28.73 % of certificates. Similarly, there were mistakes that could be amended in 53.52% of the cases. Specific mistakes were identified in the medical-legal handling of the death certificate.