Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Krywanczyk, Amoresano, Mount).
Autopsy Department, St. Louis University, St. Louis, Missouri (Tatsumi). Krywanczyk is currently at the Autopsy Department of the Cuyahoga County Medical Examiner's Office, Cleveland, Ohio. Amoresano is currently at the Autopsy Department of the Office of the Chief Medical Examiner, Baltimore, Maryland.
Arch Pathol Lab Med. 2020 Sep 1;144(9):1092-1096. doi: 10.5858/arpa.2019-0452-OA.
CONTEXT.—: Despite the importance of accurate death statistics for epidemiologic studies and public health initiatives, there remains a high frequency of errors in death certification. This deficiency can be addressed by the hospital autopsy service.
OBJECTIVES.—: To improve the quality and accuracy of death certificates issued in the hospital and improve resident and clinician education by initiating a death certificate review process, performed by pathology residents while on their hospital autopsy rotation.
DESIGN.—: A resident reviewed all death certificates issued in the hospital daily through the state electronic death certificate filing system and correlated with the decedent's medical record. When errors were found, the resident filed an amended death certificate with the state. If applicable, the Office of the Medical Examiner was contacted to investigate. The original certifying physician was then contacted via email with an explanation for the amendment.
RESULTS.—: In 12 months, 590 death certificates were issued by the hospital. Eighty-eight of 590 (15%) were amended. Of those 88 amended, 41 (47%) were missing an underlying cause of death, 7 (8%) had an inaccurate cause of death, 41 (47%) failed to include relevant contributory causes of death, and 17 (19%) had major typographic errors. Of 88, 24 (27%) fell under the Office of the Medical Examiner's jurisdiction and were reported with a subsequent change in the manner of death in 23 of 88 cases (26%).
CONCLUSIONS.—: Death certificate review by the autopsy service improves the accuracy of death certification, impacts resident and clinician education, and serves as quality assurance for both the hospital and the state.
尽管准确的死亡统计数据对于流行病学研究和公共卫生计划至关重要，但在死亡证明的认证中仍存在高频错误。医院尸检服务可以解决这一不足。
通过启动死亡证明审查程序，由病理住院医师在进行医院尸检轮转时完成，提高医院签发的死亡证明的质量和准确性，并改善住院医师和临床医生的教育。
住院医师通过州电子死亡证明提交系统每天审查医院发布的所有死亡证明，并与死者的病历相关联。发现错误时，住院医师向州提交经修订的死亡证明。如果适用，联系法医办公室进行调查。然后通过电子邮件联系原始认证医师，解释修订原因。
在 12 个月内，医院共签发了 590 份死亡证明。其中 88 份（15%）被修改。在这 88 份经修改的证明中，41 份（47%）缺少根本死因，7 份（8%）死因不准确，41 份（47%）未包含相关的促成死亡原因，17 份（19%）存在重大排版错误。在这 88 份证明中，24 份（27%）属于法医办公室管辖范围，并报告了随后 88 份中的 23 份（26%）的死亡方式发生变化。
尸检服务的死亡证明审查提高了死亡证明的准确性，影响了住院医师和临床医生的教育，并为医院和州提供了质量保证。
