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Quality analysis of the completion of death certificates in Madrid
Pilar Pinto Pastor1, Enrique Dorado Fernández1, Elena Albarrán Juan2
1Universidad Complutense de Madrid: Legal Medicine, Psychiatry and Pathology Department, School of Medicine, Pza. Ramón y Cajal, s/n, 28040, Madrid, Spain; Forensic Medicine, Medico-Legal Institute of Madrid, C/ de Julio Cano Lasso, 4, 28042, Madrid, Spain.
Insights
Errors in Death Certificates (DCs) are common due to inadequate training, impacting mortality statistics. Improving DC completion requires enhanced training and digitalization.
Area of Science:
- Medical-legal documentation
- Public Health
- Mortality Statistics
Background:
- Death Certificates (DCs) are crucial medical-legal documents.
- Inadequate training leads to frequent errors in DC completion.
- Errors can misclassify mortality statistics and misdirect resources.
Purpose of the Study:
- To assess the quality of Death Certificate completion in Madrid.
- To identify common errors in DC completion.
- To propose strategies for improving DC accuracy and utility.
Main Methods:
- Analysis of 1974 Death Certificates (DCs) from Madrid.
- Evaluation of demographic, personal, and causal information accuracy.
- Assessment of document usage and error rates.
Main Results:
- Demographic and personal data were mostly accurate.
- 16.2% of cases did not use the official DC.
- 91% of DCs contained errors (major or minor), with 38.4% having incorrect cause-of-death chains.
Conclusions:
- Increased training for certifiers, starting at the undergraduate level and including workshops, is essential.
- Digitalization of DCs in Spain is recommended to facilitate completion.
- Standardized documentation for medical examiners is proposed to improve natural and violent death statistics.
Abstract:
The Death Certificate (DC) is an important medical-legal. However, despite its importance, the professionals involved are not well trained and consequently there exist many errors in completion. This situation can cause misclassification in mortality statistics, but also it means that many natural deaths end up being studied by the medical examiner, entailing a waste of resources. An analysis of 1974 DCs in Madrid is carried out to assess the quality of the completion, discover the main errors in the certificates and analyse possible improvement strategies. The study highlights that the demographic and personal information about the deceased is mostly correct; in 16,2 % of the cases the official document was not used; 91 % of the DCs in the sample have a certain degree of error (major or minor); and 38,4 % of the documents chain of causes were incorrect. The main measure proposed is increased training for certifiers, which should begin with activities at undergraduate level and continue later with periodic training workshops. In addition, we consider it essential to digitalise DCs in Spain. This would greatly facilitate completion. It is also proposed that medical examiners use, in Spain, a document similar to the official DC so that the statistics of violent and natural deaths which have required the medical examiners' intervention will improve.
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