Errors in issuing death certificates. An analysis of 10,000 deaths from Mecklenburg

摘要

Long-lasting discussions on the problems associated with the (primary) external post-mortem examination of the corpse have so far not led to any improvements in Germany. During the second external post-mortem examination prior to cremation, the responsible physicians still encounter numerous and even serious errors made by the physicians who conducted the primary external post-mortem examination and the issuing of the death certificate.The present study assessed how many consecutive death certificates from Mecklenburg-Vorpommern have been deficiently issued in a given period in the catchment area of the Rostock crematorium and which errors were the most common. The aim was to draw conclusions from these findings for the training of medical students and physicians, on the quality/suitability of the currently valid death certificate and the quality of the current practice of external post-mortem examination in Mecklenburg-Vorpommern.In this study 10,000 consecutive death certificates (part 3 of the confidential part) from August 2012 to May 2015 were evaluated for errors in form and content as well as minor and serious errors. They were grouped into the categories "clinician", "private practitioner", "emergency physician" and "unknown". The errors were defined according to the legal specifications and instructions for the issuing of death certificates.On the basis of equal ranking of minor and serious errors only 223 of the 10,000 death certificates (2.23) had been issued error-free. A total number of 38,852 errors were found in the 9777 deficiently issued death certificates (97.77). The 3116 serious errors identified were dominated by an impossible causality between cause of death and clinical findings (n = 1268, 12.68), followed by the unavailability of the physician who was responsible for the primary external post-mortem examination due to incorrect data (n = 1203, 12.03) and the lack of notation of the signs of death (n = 295, 2.95). The worst results were found among physicians who could not be classified into the categories "clinician", "private practitioner" or "emergency physician" due to the lack of entries or a personalized stamp (unknown).The current practice of issuing death certificates in Germany is unsatisfactory and should be profoundly revised. To improve the situation structural changes, the introduction of a uniform nationwide death certificate and the extension of the period of time for the issuing of death certificates are recommended.