[Quality control of deaths in hospitals].
BACKGROUND
Deaths at Akershus University Hospital were systematically reviewed to evaluate the quality of death certificates and to improve reporting of deaths by unnatural causes.


METHODS
Death certificates and medical records from the 496 patients who died at Akershus University Hospital in the period 1 May-31 December 2008 (8 months), were reviewed prospectively. Doctors were contacted when death certificates had an illogical set-up, when important clinical findings were not reported, and upon suspicion of unnatural death or a lethal adverse drug reaction. For comparison, 134 deaths that occurred in March 2007 and March 2008 were evaluated retrospectively.


RESULTS
27 % of death certificates in the control period and 20 % of those in the project period had either a combination of incorrect content and a logical set-up or incorrect content and an illogical set-up. In the project period, the percentage of death certificates with logical set-ups increased from 64 % to 76 % (p = 0.047) and the percentage of correct set-ups increased from 76 % to 84 % (p = 0.029). The percentage of deaths by unnatural causes was 12 % in the project period and 7 % in the control periods; lethal adverse drug reactions comprised 5 % of deaths in the project period and 7 % of those in the control periods.


CONCLUSIONS
All deaths should be reviewed to increase accuracy of cause-of-death statistics and to adhere to reporting routines founded in Norwegian law. Follow-up of deaths in hospitals should be centralized; a consultant pathologist or a physician with similar competence should be responsible. Continuous feedback to clinicians will increase the quality of death certificates and raise awareness of law-based reporting routines.
Patologisk anatomisk avdeling Laboratoriesenteret, Akershus universitetssykehus 1478 Lørenskog, og Medisinsk fakultet, Universitetet i Oslo. cecilie.alfsen@medisin.uio.no
G Cecilie
GC
Alfsen
Lars Gustav
LG
Lyckander
Anne Wenche
AW
Lindboe
Helge
H
Svaar
D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D011786:Quality Control; D012042:Registries; D012189:Retrospective Studies
Kvalitetssikring ved dødsfall i sykehus.