Quality analysis of the completion of death certificates in Madrid.

The Death Certificate (DC) is an important medical-legal. However, despite its importance, the professionals involved are not well trained and consequently there exist many errors in completion. This situation can cause misclassification in mortality statistics, but also it means that many natural deaths end up being studied by the medical examiner, entailing a waste of resources. An analysis of 1974 DCs in Madrid is carried out to assess the quality of the completion, discover the main errors in the certificates and analyse possible improvement strategies. The study highlights that the demographic and personal information about the deceased is mostly correct; in 16,2 % of the cases the official document was not used; 91 % of the DCs in the sample have a certain degree of error (major or minor); and 38,4 % of the documents chain of causes were incorrect. The main measure proposed is increased training for certifiers, which should begin with activities at undergraduate level and continue later with periodic training workshops. In addition, we consider it essential to digitalise DCs in Spain. This would greatly facilitate completion. It is also proposed that medical examiners use, in Spain, a document similar to the official DC so that the statistics of violent and natural deaths which have required the medical examiners' intervention will improve.