Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1998 May 19;158(10):1317–1323.

Improving the accuracy of death certification

K A Myers 1, D R Farquhar 1
PMCID: PMC1229326  PMID: 9614825

Abstract

BACKGROUND: Population-based mortality statistics are derived from the information recorded on death certificates. This information is used for many important purposes, such as the development of public health programs and the allocation of health care resources. Although most physicians are confronted with the task of completing death certificates, many do not receive adequate training in this skill. Resulting inaccuracies in information undermine the quality of the data derived from death certificates. METHODS: An educational intervention was designed and implemented to improve internal medicine residents' accuracy in death certificate completion. A total of 229 death certificates (146 completed before and 83 completed after the intervention) were audited for major and minor errors, and the rates of errors before and after the intervention were compared. RESULTS: Major errors were identified on 32.9% of the death certificates completed before the intervention, a rate comparable to previously reported rates for internal medicine services in teaching hospitals. Following the intervention the major error rate decreased to 15.7% (p = 0.01). The reduction in the major error rate was accounted for by significant reductions in the rate of listing of mechanism of death without a legitimate underlying cause of death (15.8% v. 4.8%) (p = 0.01) and the rate of improper sequencing of death certificate information (15.8% v. 6.0%) (p = 0.03). INTERPRETATION: Errors are common in the completion of death certificates in the inpatient teaching hospital setting. The accuracy of death certification can be improved with the implementation of a simple educational intervention.

Full Text

The Full Text of this article is available as a PDF (177.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barber J. B. Improving accuracy of death certificates. J Natl Med Assoc. 1992 Dec;84(12):1007–1008. [PMC free article] [PubMed] [Google Scholar]
  2. Curb J. D., Babcock C., Pressel S., Tung B., Remington R. D., Hawkins C. M. Nosological coding of cause of death. Am J Epidemiol. 1983 Jul;118(1):122–128. doi: 10.1093/oxfordjournals.aje.a113613. [DOI] [PubMed] [Google Scholar]
  3. Hanzlick R. Death certificates. The need for further guidance. Am J Forensic Med Pathol. 1993 Sep;14(3):249–252. [PubMed] [Google Scholar]
  4. Hanzlick R. Improving accuracy of death certificates. JAMA. 1993 Jun 9;269(22):2850–2850. [PubMed] [Google Scholar]
  5. Hunt L. W., Jr, Silverstein M. D., Reed C. E., O'Connell E. J., O'Fallon W. M., Yunginger J. W. Accuracy of the death certificate in a population-based study of asthmatic patients. JAMA. 1993 Apr 21;269(15):1947–1952. [PubMed] [Google Scholar]
  6. Jordan J. M., Bass M. J. Errors in death certificate completion in a teaching hospital. Clin Invest Med. 1993 Aug;16(4):249–255. [PubMed] [Google Scholar]
  7. Kircher T., Nelson J., Burdo H. The autopsy as a measure of accuracy of the death certificate. N Engl J Med. 1985 Nov 14;313(20):1263–1269. doi: 10.1056/NEJM198511143132005. [DOI] [PubMed] [Google Scholar]
  8. Lomas J., Anderson G. M., Domnick-Pierre K., Vayda E., Enkin M. W., Hannah W. J. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989 Nov 9;321(19):1306–1311. doi: 10.1056/NEJM198911093211906. [DOI] [PubMed] [Google Scholar]
  9. Maudsley G., Williams E. M. Death certification by house officers and general practitioners--practice and performance. J Public Health Med. 1993 Jun;15(2):192–201. [PubMed] [Google Scholar]
  10. McKelvie P. A. Medical certification of causes of death in an Australian metropolitan hospital. Comparison with autopsy findings and a critical review. Med J Aust. 1993 Jun 21;158(12):816-8, 820-1. [PubMed] [Google Scholar]
  11. Nielsen G. P., Björnsson J., Jonasson J. G. The accuracy of death certificates. Implications for health statistics. Virchows Arch A Pathol Anat Histopathol. 1991;419(2):143–146. doi: 10.1007/BF01600228. [DOI] [PubMed] [Google Scholar]
  12. Pain C. H., Aylin P., Taub N. A., Botha J. L. Death certification: production and evaluation of a training video. Med Educ. 1996 Nov;30(6):434–439. doi: 10.1111/j.1365-2923.1996.tb00864.x. [DOI] [PubMed] [Google Scholar]
  13. Slater D. N. Certifying the cause of death: an audit of wording inaccuracies. J Clin Pathol. 1993 Mar;46(3):232–234. doi: 10.1136/jcp.46.3.232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Weeramanthri T., Beresford B. Death certification in Western Australia--classification of major errors in certificate completion. Aust J Public Health. 1992 Dec;16(4):431–434. doi: 10.1111/j.1753-6405.1992.tb00092.x. [DOI] [PubMed] [Google Scholar]
  15. Weeramanthri T., Beresford W., Sathianathan V. An evaluation of an educational intervention to improve death certification practice. Aust Clin Rev. 1993;13(4):185–189. [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES