Abstract
INTRODUCTION
Death certification is a legal requirement. By law, deaths must be registered within 5 days of receipt of the MCCD by the registrar unless there is to be a coroner’s investigation. Prompt and accurate completion is essential because it enables the death to be registered and provides a permanent legal record of the fact and cause of death. It allows the family to make funeral arrangements and to begin the process of settling the deceased person’s estates. Delays in producing death certificates can cause significant distress to grieving families . This QIP looked at a ward’s speed of completing certification and strategies to improve this.
METHODOLOGY
All deaths on a Geriatrics ward were reviewed across three time periods. These were pandemic deaths occurring April 2020 - November 2021, the immediate post-pandemic period November 2021 - November 2022 and during ‘normal service’ November 2023 - March 2024. Correlation was sought between ‘date of death’ and ‘date the death certificate was received by the Medical Examiner’. Different methods to increase speed of completion were trialled during ‘normal service’, these included teaching sessions by the Medical Examiner and proactively assigning certificates to doctors each morning. Re-audit was done to test the efficacy of improvement strategies.
RESULTS
The ‘average delay’ during the Pandemic, Post-Pandemic and Normal services was around 4.5 days , 2 days and 2.5 days respectively and the ‘longest delay’ was 13 days, 9 days and 6 days respectively. With improvement strategies the average delay was 1 day and the longest delay was 7 days.
Delays were more frequent when death occurred closer to the weekend , on Fridays or Thursdays.
Most certificates were completed by SHO’s and Foundation doctors.
CONCLUSION
Clinical pressures can result in unacceptable delays in death certification. Results from re-audit have proved that Strategies to expedite completion like increasing confidence through education, assigning clear tasks and group discussion of recent deaths have helped in reducing delays .
REFERENCES
An overview of the death certification reforms - GOV.UK
https://www.gov.uk/government/publications/medical-certificate-of-cause…
Adeyinka A, Bailey K. Death Certification. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526015/
Pandya H, Bose N, Shah R, Chaudhury N, Phatak A. Educational intervention to improve death certification at a teaching hospital. Natl Med J India. 2009 Nov-Dec;22(6):317-9. PMID: 20384023.
Lakkireddy DR, Basarakodu KR, Vacek JL, Kondur AK, Ramachandruni SK, Esterbrooks DJ, Markert RJ, Gowda MS. Improving death certificate completion: a trial of two training interventions. J Gen Intern Med. 2007 Apr;22(4):544-8. [PMC free article] [PubMed]
*MCCD - Medical certificate of cause of death