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Performance data and the mortuary register
1Department of Public Health Sciences, St George's Hospital Medical School, London, UK. j.poloniecki@sghms.ac.uk
Insights
Hospital record-keeping for cardiac surgery deaths is often inaccurate. Fewer than 80% of actual deaths were recorded, and mortuary data updates were delayed, impacting accuracy.
Area of Science:
- Healthcare Informatics
- Surgical Outcomes Research
- Medical Record Management
Background:
- Accurate tracking of patient mortality is crucial for evaluating surgical outcomes and hospital performance.
- Discrepancies in death record-keeping can lead to flawed data analysis and reporting.
Purpose of the Study:
- To compare the accuracy of in-hospital death records derived from departmental, hospital information systems, and mortuary sources following cardiac surgery.
- To identify discrepancies in death ascertainment and reporting timelines.
Main Methods:
- A matched pairs comparison design was employed, contrasting historical and contemporary records from different sources.
- Data from cardiac surgical operations, departmental databases, hospital administration systems, and mortuary logs were analyzed.
- The primary outcome measure was the difference in recorded in-hospital deaths across these sources.
Main Results:
- A small percentage (0.15%) of cardiac surgery patients were incorrectly coded as alive upon discharge.
- Fewer than 80% of actual cardiac surgery deaths were accurately captured in departmental or hospital administration systems.
- Significant delays in updating hospital records were observed, with 9% of mortuary deaths taking over 6 working days to record, and inaccuracies in dates of death occurred in 3.5% of cases.
Conclusions:
- Mortuary staff engagement can enhance the accuracy of patient death counts.
- Publication of death rates and performance metrics requires rigorous statistical peer review to ensure data integrity.
Objective:
To compare departmental records of deaths after cardiac surgery with the hospital's information system.
Design:
Matched pairs comparisons: (i) historic record compared with current record from another source; (ii) contemporary records from different sources; and (iii) timed records from different sources.
Setting:
Regional cardiothoracic units at St George's and St. Thomas's Hospitals.
Subjects:
2664 cardiac surgical operations at St George's between January 1992 and June 1994, 215 deaths in the cardiac surgery database at St Thomas's between April 1993 and March 1997, 120 in-hospital deaths received by the mortuary at St George's during June 1999.
Main Outcome Measures:
The difference in the number of in-hospital deaths from departmental, hospital, and mortuary sources.
Results:
Four of 2664 operations (0.15%) had been incorrectly coded as leaving hospital alive. Fewer than 80% of the actual number of deaths after cardiac surgery at St Thomas's had been recorded on either the departmental database or the hospital administration system. For 9% of deaths received in the mortuary, it took more than 6 working days for the hospital record to be updated, and at the time of reporting 1 case had not been updated after 14 working days: the date of death was inaccurate in 4/113 (3.5%) of cases.
Conclusions:
The mortuary staff can contribute to improving the accuracy of body counts. Death rates and performance data should not be published without statistical peer review.