title: A good death certificate: improved performance by simple educational measures.
abstract: OBJECTIVE
  The initial aim of this audit was to determine whether information on death certificates is correct and all legal requirements are met. As shortcomings were found, educational measures were undertaken and the effect of those was measured by a re-audit.
  
  
  METHODS
  All death certificates issued during a 4-month period within the elderly care department of a district general hospital were retrospectively audited. A re-audit was performed later the same year over a 3-month period.
  
  
  RESULTS
  19 (13.6%) of 140 certificates issued during the initial 4-month period could not be shown to meet the statutory criteria, as no evidence was found that these patients were attended by the issuing medical officer. Minor errors and omissions were found in 58.6% of certificates. Following education about these problems, there was a significant improvement in death certification. Only 2 (2.4%) of 85 certificates issued in the re-audit period did not meet the statutory criteria (p = 0.01) and minor errors and omissions occurred in 20%.
  
  
  CONCLUSIONS
  The incidence of unsatisfactory death certificates within a hospital setting is high. Increased education and better documentation leads to improvements in accuracy and legitimacy.
authors.affiliation: Department of Medicine for the Elderly, Airedale General Hospital, Keighley, UK. christian.selinger@web.de
authors.forename: Christian P
authors.initials: CP
authors.lastname: Selinger
authors.forename: Robert A
authors.initials: RA
authors.lastname: Ellis
authors.forename: Mary G
authors.initials: MG
authors.lastname: Harrington
mesh_terms: D002423:Cause of Death; D002983:Clinical Competence / Q000592:standards; D003644:Death Certificates; D004739:England; D006801:Humans; D008485:Medical Audit; D008499:Medical Records / Q000592:standards; D008505:Medical Staff, Hospital / Q000193:education / Q000592:standards*; D012189:Retrospective Studies