Azim Afzal, Singh Parikshit, Bhatia Parmeet, Baronia Arvind K, Gurjar Mohan, Poddar Banani, Singh Ratender K
Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):78-81. doi: 10.4103/0970-9185.125708.
A high incidence of errors occur while filling up death certificates in hospitals. The purpose of this study was to analyze the impact of an educational intervention on errors in death certification in an intensive care unit (ICU). Patients admitted to ICUs by virtue of being critically ill have a higher mortality than other hospitalized patients. This study was designed to see if any improvement could be brought about in filling death certificates.
Educating sessions, interactive workshops, and monthly audits for the department resident doctors were conducted. One hundred and fifty death certificates were audited for major and minor errors (75 before and 75 after the educational intervention) over a period of 18 months. Fisher's exact test was applied to statistically analyze the data.
There was a significant decrease in major errors like mechanism without underlying cause of death (60.0 vs. 14.6%, P < 0.001), competing causes (88.0 vs. 13.3%, P < 0.001), and improper sequencing (89.3 vs. 36.0%, P < 0.001). There was also a significant decrease in minor errors such as use of abbreviations (89.3 vs. 29.3%, P < 0.001) and no time intervals (100.0 vs. 22.6%, P < 0.001).
Authors conclude that death certification errors can be significantly reduced by educational interventional programs.
医院在填写死亡证明时错误发生率很高。本研究的目的是分析教育干预对重症监护病房（ICU）死亡证明错误的影响。因病情危急而入住ICU的患者死亡率高于其他住院患者。本研究旨在观察在填写死亡证明方面是否能有所改进。
为科室住院医生举办教育课程、互动研讨会并进行月度审核。在18个月的时间里，对150份死亡证明进行了重大和微小错误审核（教育干预前75份，教育干预后75份）。应用Fisher精确检验对数据进行统计分析。
重大错误显著减少，如无潜在死因的机制（60.0%对14.6%，P<0.001）、相互竞争的死因（88.0%对13.3%，P<0.001）以及顺序不当（89.3%对36.0%，P<0.001）。微小错误也显著减少，如使用缩写（89.3%对29.3%，P<0.001）和无时间间隔（100.0%对22.6%，P<0.001）。
作者得出结论，通过教育干预项目可显著减少死亡证明错误。
