Frequency and types of errors in clinician-composed death certificates for patients with or without autopsy in a hospital population

Abstract Background Death certificate (DC) errors are common. At our institution, all deaths have a preliminary death certificate (PDC) written by a clinician and then revised by a pathologist prior to the clinician signing the final death certificate (FDC). In autopsy cases, the FDC is signed by the pathologist who performs the autopsy. Methods A total of 100 in-hospital deaths (50 with autopsy and 50 without) occurred in 2020 were arbitrarily selected from a tertiary care center. All PDCs and FDCs were compared to identify/classify errors as major (incorrect cause of death (COD) or significant contributing factors) or minor (abbreviations, inappropriate non-essential contributing factors, immediate/intermediate COD errors). Frequency of PDC errors was compared by autopsy status, duration of hospital stay and PDC author. Results Ninety percent of cases had at least one PDC error and 39% had a major error. Major errors were more common in autopsy cases (50% versus 28%, P = 0.035), although minor/overall errors were not. Error rates did not significantly differ for the other variables assessed. Conclusions There is significance of having a pathologist review and revise DCs before they are signed. The increased frequency in major errors in cases with autopsy suggests that autopsy findings provided additional information to elucidate COD.