Aim: To identify the frequency and types of errors in Medical Certificate Cause of Death (MCCD) completed by hospital medical officers for deceased older patients.
Methods: Among 127 deaths in a tertiary hospital acute geriatric unit between 1st July 2021 and 30th June 2022, a cause of death was documented for 116 patients (mean age 87.8 +/- 5.7 years, 46.6% female, 38.9% from nursing home). The MCCD were evaluated for errors as compared with national guidelines based on five criteria: mechanism without underlying cause, competing causes, improper sequencing, incomplete data, and use of abbreviations. The level of training of the documenting medical officer and whether the MCCD was completed out of usual working hours was evaluated with respect to errors.
Results: At least one error was present in 60 (51.7%) of MCCD evaluated, and two or more errors in 16 (13.8%). Most commonly, documenting competing causes of death was found in 45 (38.8%) of all MCCD, followed by missing data (9.5%) and improper sequencing (8.6%). MCCDs were mostly completed by Post-Graduate Year (PGY) 1 or 2 medical officers (77.6%) and out-of-hours (in 72.4%). There was no significant difference in frequency of errors between junior and senior medical officers (p = .52) or if completed within and out-of-hours (p =.14).
Conclusions: Often the MCCD contained an error for deceased hospital patients. Major improvement in the quality of death certification is needed amongst all medical officers.