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• Cause-of-death (COD) on death certificates (DCs) impacts:• Epidemiology tracking• Research• Public health interventions• Insurance payout• Justice
• National resources but no formal training for physicians• 24-hour time period• Reviewing hospital records best method to determine errors
• Retrospective sample, one institution, 1/1/2019 - 12/31/2019• Exclusion criteria:
• Final DC could not be obtained• Limited medical record
• Minor errors: do not affect interpretation of COD• Typographic errors (abbreviations, typos)• Omitted intervals• Multiple entries on Line A
• Major errors: affect interpretation of COD (according to CDC)• Non-specific COD• Omitted significant conditions• Inaccurate underlying sequence of events
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Error Occurrence in Death Certification: Improving Accuracy with Educational InterventionCara Logan1, Ashley Marler1, Stella Self2, CMG Schammel1,3, Michael Ward1,3, James Fulcher1,3, Grace Dukes1,3
1University of South Carolina School of Medicine Greenville, Greenville SC2Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Greenville SC
3Pathology Associates, Greenville SC
Introduction
Methods
Discussion + Future Direction
References
• Current educational initiatives are lengthy + outdated → create condensed learning module with summary sheet
Results
Minor error: include interval (general term or “unknown” acceptable)
Minor error: eliminate abbreviationsMinor error: check spelling
MAJOR ERROR: make sure sequence is accurate
Also:
MAJOR ERROR: include other significant conditions
MAJOR ERROR: list specific COD
More information needed if:• Abscess, ascites, infection• Altered mental status, dementia, seizure• Anemia, anoxia, aspiration • Arrhythmia, atrial/ventricular fibrillation, ventricular tachycardia• Ascites• Sepsis, shock• Bowel obstruction/perforation• Brain injury, stroke• Cancer • Dehydration, diarrhea, failure to thrive• Hemorrhage• Hyperglycemia, hyperkalemia • Hyponatremia, hypotension • Immunosuppression• Myocardial infarction• Organ disease, failure• Old age, trauma, paralysis, sudden death• Pleural effusion • Pulmonary edema, pulmonary embolism
1% 8%
91%
Frequency and Types of Errors
No errors
Minor errors only
At least one major error
N=125
19.3% major errors only80.7% both minor and major errors
Note: multiple major errors in 32% of all DCs
18.4
82.4
45.6
0
10
20
30
40
50
60
70
80
90
100Percentage of Major Error Types
Non-specific COD
Other sig condomittedInaccuratesequence of events
Note: multiple major errorsin 32% of all DCs
Email: [email protected]
FundingSpecial thank you to
the Sargent Foundation for
funding my work!
Scan to see the CDC’s recommendationson completing DCs!