A Review of the Accuracy of Death Certification on the Intensive Care Unit and the Proposed Reforms to the Coroner's System

Abstract

The requirement for the certification of death in the United Kingdom (UK) is currently undergoing unprecedented change, partly because of the Shipman Inquiry. Doctors undergo little training in completion of death certificates and inaccuracies can therefore arise. This survey compares the causes of death of 30 patients as cited by trainees, consultant intensivists and a consultant pathologist in one intensive care unit. We also review the changes in death certification that may be instituted as a result of proposed reforms to current legislation.

Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia

“…Deficiencies with death certification in the UK have been highlighted previously in the earliest confidential enquiry into perioperative deaths and problems remain. 19 The use of death certification is retrospective, identifies mortality but not morbidity, relies on accurate certification data, and analysis of individual cases is problematic. In this project, we chose a prospective methodology with a system of local reporters to identify cases.…”

Review of errors in the issue of medical certificates of cause of death in a tertiary hospital in Ghana

“…This is similar to findings in a study by Tuffin et al that showed that majority of death certificates were completed by junior doctors. 3 In their study they concluded that "junior doctors rarely receive formal training in the completion of MCCDs; nor is knowledge of the correct procedures involved in completing a MCCD required for competency based training in any of the four hospital specialties audited". 3 This they believe accounted for the high rate of errors.…”

“…3 In their study they concluded that "junior doctors rarely receive formal training in the completion of MCCDs; nor is knowledge of the correct procedures involved in completing a MCCD required for competency based training in any of the four hospital specialties audited". 3 This they believe accounted for the high rate of errors. The same situation pertains in our setting where there is little structured teaching on the completion of MCCDs.…”

“…Studies elsewhere have shown that the clinical information entered on death certificates does not allow the construction of a logical cause of death, and that up to 10% are completed to a poor standard, and further, only 55% are completed to a minimum standard. 3 In some centers it was found that up 82% of MCCDs contain one or more errors. 3 There is as yet no study known to us dealing with the types of errors in death certification in Ghana.…”

“…3 In some centers it was found that up 82% of MCCDs contain one or more errors. 3 There is as yet no study known to us dealing with the types of errors in death certification in Ghana. The aim of this study was to determine the types of errors in the completed MCCDs in a teaching hospital in Ghana, discuss these errors and make recommendations aimed at improving death certification and registration in Ghana.…”