error occurrence in death certification: improving

• Cause-of-death (COD) on death certificates (DCs) impacts: • Epidemiology tracking • Research • Public health interventions • Insurance payout • Justice • National resources but no formal training for physicians • 24-hour time period • Reviewing hospital records best method to determine errors • Retrospective sample, one institution, 1/1/2019 - 12/31/2019 • Exclusion criteria: • Final DC could not be obtained • Limited medical record • Minor errors: do not affect interpretation of COD • Typographic errors (abbreviations, typos) • Omitted intervals • Multiple entries on Line A • Major errors: affect interpretation of COD (according to CDC) • Non-specific COD • Omitted significant conditions • Inaccurate underlying sequence of events Scan for my selected reference list Error Occurrence in Death Certification: Improving Accuracy with Educational Intervention Cara Logan 1 , Ashley Marler 1 , Stella Self 2 , CMG Schammel 1,3 , Michael Ward 1,3 , James Fulcher 1,3 , Grace Dukes 1,3 1 University of South Carolina School of Medicine Greenville, Greenville SC 2 Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Greenville SC 3 Pathology Associates, Greenville SC Introduction Methods Discussion + Future Direction References • Current educational initiatives are lengthy + outdated → create condensed learning module with summary sheet Results Minor error: include interval (general term or “unknown” acceptable) Minor error: eliminate abbreviations Minor error: check spelling MAJOR ERROR: make sure sequence is accurate Also: MAJOR ERROR: include other significant conditions MAJOR ERROR: list specific COD More information needed if: • Abscess, ascites, infection • Altered mental status, dementia, seizure • Anemia, anoxia, aspiration • Arrhythmia, atrial/ventricular fibrillation, ventricular tachycardia • Ascites • Sepsis, shock • Bowel obstruction/perforation • Brain injury, stroke • Cancer • Dehydration, diarrhea, failure to thrive • Hemorrhage • Hyperglycemia, hyperkalemia • Hyponatremia, hypotension • Immunosuppression • Myocardial infarction • Organ disease, failure • Old age, trauma, paralysis, sudden death • Pleural effusion • Pulmonary edema, pulmonary embolism 1% 8% 91% Frequency and Types of Errors No errors Minor errors only At least one major error N=125 19.3% major errors only 80.7% both minor and major errors Note: multiple major errors in 32% of all DCs 18.4 82.4 45.6 0 10 20 30 40 50 60 70 80 90 100 Percentage of Major Error Types Non-specific COD Other sig cond omitted Inaccurate sequence of events Note: multiple major errors in 32% of all DCs Email: [email protected] Funding Special thank you to the Sargent Foundation for funding my work! Scan to see the CDC’s recommendations on completing DCs!

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Page 1: Error Occurrence in Death Certification: Improving

• Cause-of-death (COD) on death certificates (DCs) impacts:• Epidemiology tracking• Research• Public health interventions• Insurance payout• Justice

• National resources but no formal training for physicians• 24-hour time period• Reviewing hospital records best method to determine errors

• Retrospective sample, one institution, 1/1/2019 - 12/31/2019• Exclusion criteria:

• Final DC could not be obtained• Limited medical record

• Minor errors: do not affect interpretation of COD• Typographic errors (abbreviations, typos)• Omitted intervals• Multiple entries on Line A

• Major errors: affect interpretation of COD (according to CDC)• Non-specific COD• Omitted significant conditions• Inaccurate underlying sequence of events

Scan for my selected

reference list

Error Occurrence in Death Certification: Improving Accuracy with Educational InterventionCara Logan1, Ashley Marler1, Stella Self2, CMG Schammel1,3, Michael Ward1,3, James Fulcher1,3, Grace Dukes1,3

1University of South Carolina School of Medicine Greenville, Greenville SC2Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Greenville SC

3Pathology Associates, Greenville SC

Introduction

Methods

Discussion + Future Direction

References

• Current educational initiatives are lengthy + outdated → create condensed learning module with summary sheet

Results

Minor error: include interval (general term or “unknown” acceptable)

Minor error: eliminate abbreviationsMinor error: check spelling

MAJOR ERROR: make sure sequence is accurate

Also:

MAJOR ERROR: include other significant conditions

MAJOR ERROR: list specific COD

More information needed if:• Abscess, ascites, infection• Altered mental status, dementia, seizure• Anemia, anoxia, aspiration • Arrhythmia, atrial/ventricular fibrillation, ventricular tachycardia• Ascites• Sepsis, shock• Bowel obstruction/perforation• Brain injury, stroke• Cancer • Dehydration, diarrhea, failure to thrive• Hemorrhage• Hyperglycemia, hyperkalemia • Hyponatremia, hypotension • Immunosuppression• Myocardial infarction• Organ disease, failure• Old age, trauma, paralysis, sudden death• Pleural effusion • Pulmonary edema, pulmonary embolism

1% 8%

91%

Frequency and Types of Errors

No errors

Minor errors only

At least one major error

N=125

19.3% major errors only80.7% both minor and major errors

Note: multiple major errors in 32% of all DCs

18.4

82.4

45.6