4 Improving compliance with statutory death certification, at a city centre tertiary teaching hospital: A quality improvement project

Abstract

Introduction Medical certificate cause of death form (MCCD) completion is seen as a daunting process, especially for junior medical staff. Death certification is an expectation of all doctors, as set by the general medical council. Quick completion of medical examiner referral forms (MERFs) and MCCDs positively impacts on patients' families. This requires confidence and knowledge in certifying death, which this quality improvement project aims to assess and improve. Method We brainstormed our stakeholders, created a driver diagram and SMART aims: 1) For 100% and 75% of MCCD's to be completed within five and three days from death, respectively and 2) To improve junior doctor confidence in the death certification process at Manchester Foundation Trust (MFT). We collected qualitative data through an anonymized survey and quantitative data including time from death to MERF and MCCD completion from December 2020 -March 2021. Our interventions included teaching incoming junior doctors and creating visual aids to display in key clinical areas. The above data was re-audited from September -October 2021. Results Almost all of MCCDs were completed within five days, 95% (129/136), versus pre-intervention findings of 98% (128/133). The number of MCCDs completed within three days improved from 51% (68/133) pre-intervention to 66% (90/136) post-intervention. Confidence in completing MCCDs improved from 0% to 33%. MCCD completion times varied widely and there were a significant number of patients in whom it was not within the legal requirement of five days. Despite education and visual aids, junior doctors at MFT feel that there should be more senior support when completing MCCDs. There needs to be ongoing education around death certification including annual face-to-face teaching sessions for incoming junior doctors. Conclusion Junior doctors lack confidence and insight into the responsibility surrounding MCCD completion at MFT. This needs to be addressed through ongoing focus and education.