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Errors in cause-of-death statement on death certificates in intensive care unit of Kathmandu, Nepal.

Maharjan L, Shah A, Shrestha KB, Shrestha G - BMC Health Serv Res (2015)

Bottom Line: The study found errors in 78.4 % of DCs.The error in DC was found to be statistically significant with the severity of sepsis (p = 0.003), and presence of chronic organ failures (p = 0.034).Age, time of death, source of admission, and duration of ICU stay were not found to be statistically associated with the errors in DC.

View Article: PubMed Central - PubMed

Affiliation: Blue Cross Hospital, Kathmandu, Nepal. leison.maharjan@gmail.com.

ABSTRACT

Background: Death certificates (DC) are one of the most important medico-legal documents that physicians work through. DCs are extensively used in health statistics for epidemiological studies, and in health policy planning as a public health resource tool. Cause-of-death (COD) statement, which is vulnerable to various errors, is the vital part of a DC that has the potential to mislead the policy makers and statisticians. Hence, we evaluated and analyzed the errors prevalent in COD statement of DC.

Methods: A retrospective observational study was conducted at medical Intensive Care Unit (ICU) of Blue Cross Hospital, Kathmandu, Nepal within two years of study period. A total of 204 medical records of the deceased patients were reviewed. Three sub-headings of COD statement of DC- Part I Immediate COD (ICOD), Part I Underlying COD (UCOD), and Part II Other significant conditions (OSC) were extensively evaluated for the major medical errors.

Results: The study found errors in 78.4 % of DCs. The highest number of errors was in UCOD (83 %). Most common errors were "Mechanism of Death- terminal event" in ICOD, "More than one competing causes" in UCOD, and "OSC present but not listed" in OSC. The error in DC was found to be statistically significant with the severity of sepsis (p = 0.003), and presence of chronic organ failures (p = 0.034). Age, time of death, source of admission, and duration of ICU stay were not found to be statistically associated with the errors in DC.

Conclusion: Prevalence of errors in DC was quite high. Most errors were committed in underlying cause of death, which is the most important part of DC. Complexity of the cases was the key factor that increased the risks of committing errors. Specific education should supersede general educational interventions to minimize the errors considerably in writing DC in complex cases.

No MeSH data available.


Related in: MedlinePlus

Venn diagram showing distribution of errors in different parts of death certificates
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Fig1: Venn diagram showing distribution of errors in different parts of death certificates

Mentions: In this study, we found errors in 160 (78.4 %) DCs. The highest error rate was found in sub-heading UCOD in 133 DCs followed by ICOD in 80 DCs and OSC in 79 DCs. About 20 % of 160 erroneous DCs had errors in all three subheadings (ICOD, UCOD and OSC), whereas 68 DCs and 60 DCs had errors in two and one subheading respectively (Fig. 1).Fig. 1


Errors in cause-of-death statement on death certificates in intensive care unit of Kathmandu, Nepal.

Maharjan L, Shah A, Shrestha KB, Shrestha G - BMC Health Serv Res (2015)

Venn diagram showing distribution of errors in different parts of death certificates
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4643506&req=5

Fig1: Venn diagram showing distribution of errors in different parts of death certificates
Mentions: In this study, we found errors in 160 (78.4 %) DCs. The highest error rate was found in sub-heading UCOD in 133 DCs followed by ICOD in 80 DCs and OSC in 79 DCs. About 20 % of 160 erroneous DCs had errors in all three subheadings (ICOD, UCOD and OSC), whereas 68 DCs and 60 DCs had errors in two and one subheading respectively (Fig. 1).Fig. 1

Bottom Line: The study found errors in 78.4 % of DCs.The error in DC was found to be statistically significant with the severity of sepsis (p = 0.003), and presence of chronic organ failures (p = 0.034).Age, time of death, source of admission, and duration of ICU stay were not found to be statistically associated with the errors in DC.

View Article: PubMed Central - PubMed

Affiliation: Blue Cross Hospital, Kathmandu, Nepal. leison.maharjan@gmail.com.

ABSTRACT

Background: Death certificates (DC) are one of the most important medico-legal documents that physicians work through. DCs are extensively used in health statistics for epidemiological studies, and in health policy planning as a public health resource tool. Cause-of-death (COD) statement, which is vulnerable to various errors, is the vital part of a DC that has the potential to mislead the policy makers and statisticians. Hence, we evaluated and analyzed the errors prevalent in COD statement of DC.

Methods: A retrospective observational study was conducted at medical Intensive Care Unit (ICU) of Blue Cross Hospital, Kathmandu, Nepal within two years of study period. A total of 204 medical records of the deceased patients were reviewed. Three sub-headings of COD statement of DC- Part I Immediate COD (ICOD), Part I Underlying COD (UCOD), and Part II Other significant conditions (OSC) were extensively evaluated for the major medical errors.

Results: The study found errors in 78.4 % of DCs. The highest number of errors was in UCOD (83 %). Most common errors were "Mechanism of Death- terminal event" in ICOD, "More than one competing causes" in UCOD, and "OSC present but not listed" in OSC. The error in DC was found to be statistically significant with the severity of sepsis (p = 0.003), and presence of chronic organ failures (p = 0.034). Age, time of death, source of admission, and duration of ICU stay were not found to be statistically associated with the errors in DC.

Conclusion: Prevalence of errors in DC was quite high. Most errors were committed in underlying cause of death, which is the most important part of DC. Complexity of the cases was the key factor that increased the risks of committing errors. Specific education should supersede general educational interventions to minimize the errors considerably in writing DC in complex cases.

No MeSH data available.


Related in: MedlinePlus