Death Certification: Errors and Interventions
Death Certification: Errors and Interventions
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DOI：
10.3121/cmr.2019.1496
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发表时间：
2020-03-01
影响因子：
1.4
通讯作者：
Brooks, Erin G.
中科院分区：
文献类型：
--
作者：
Schuppener, Leah M.;Olson, Kelly;Brooks, Erin G.
目的：死亡证明书是包含关键信息的法律的文件。尽管准确的认证很重要，但错误仍然很常见。对错误发生率的估计在不同的研究之间存在差异，错误分类系统往往不清楚。相对较少的研究评估了美国医院死亡证明错误发生的频率，甚至更少的研究试图根据其严重程度对错误进行标准化分类。在当前的研究中，我们的目标是评估学术中心死亡认证错误的频率，实施错误严重程度分类的标准化方法，并分析错误的来源，以更好地确定提高死亡认证准确性的方法。设计：我们回顾性分析了179例尸检病例的死因和死亡证明方式的准确性2013-2016年间。我们比较了非病理学家医生完成的死亡证明书的原因和死亡方式最终确定在autoposition.Methods：错误进行了分类，通过一个5点的规模增加错误的严重程度。I-IIc级被认为是轻微错误，而III-V级被认为是严重错误。结果：在大多数情况下（85%），死亡证明书包含>=一个错误，与多个错误（51%）比单一（33%）更常见。最常见的错误类型为1级（53%），其次为III级（30%）和IIb级（18%）。在23%的病例中出现了更严重的IV级错误;没有发现V级错误。在研究期间，在最终确定尸检结果后，没有对任何死亡证明进行修改。结论：本研究重申了尸检和尸检病理学家在确保准确和完整的死亡证明中的重要性。它还表明，死亡证明错误可能比以前报告的更频繁。我们提出了一种方法，死亡证明错误可以被分类的严重程度增加。通过了解死亡证明上发生的错误类型，学术机构可以努力提高认证的准确性。建议对临床医生进行更好的教育，与尸检病理学家进行协调，并采取系统的方法确保死亡证明与尸检结果的一致性。
Objective: Death certificates are legal documents containing critical information. Despite the importance of accurate certification, errors remain common. Estimates of error prevalence vary between studies, and error classification systems are often unclear. Relatively few studies have assessed the frequency at which death certification errors occur in US hospitals, and even fewer have attempted a standardized classification of errors based on their severity. In the current study, our objective was to evaluate the frequency of death certification errors at an academic center, implement a standardized method of categorizing error severity, and analyze sources of error to better identify ways to improve death certification accuracy.Design: We retrospectively reviewed the accuracy of cause and manner of death certification at our regional academic institution for 179 cases in which autopsy was performed between 2013-2016. We compared non-pathologist physician completed death certificates with the cause and manner of death ultimately determined at autopsy.Methods: Errors were classified via a 5-point scale of increasing error severity. Grades I-IIc were considered minor errors, while III-V were considered severe. Sources of error were analyzed.Results: In the majority of cases (85%), death certificates contained >= one error, with multiple errors (51%) being more common than single (33%). The most frequent error type was Grade 1 (53%), followed by Grade III (30%), and Grade IIb (18%). The more severe Grade IV errors were seen in 23% of cases; no Grade V errors were found. No amendments were made to any death certificates following finalization of autopsy results during the study period.Conclusion: This study reaffirms the importance of autopsy and autopsy pathologists in ensuring accurate and complete death certification. It also suggests that death certification errors may be more frequent than previously reported. We propose a method by which death certification errors can be classified in terms of increasing severity. By understanding the types of errors occurring on death certificates, academic institutions can work to improve certification accuracy. Better clinician education, coordination with autopsy pathologists, and implementation of a systematic approach to ensuring concordance of death certificates with autopsy results is recommended.