# The Final Diagnosis: Evaluating Errors in Cause-of-Death Reporting

## TL;DR

This study finds that most cause-of-death certificates in a North Indian hospital contain errors, emphasizing the need for better training and adherence to guidelines.

## Contribution

The study identifies specific error rates and factors in COD reporting in North India and evaluates the impact of training on reducing errors.

## Key findings

- Only 10.38% of certificates were correctly filled, with 74.80% containing major errors.
- Training reduced errors among junior residents from 72% to 28%.
- Emergency and ICU departments had the highest error rates at 54% and 28%, respectively.

## Abstract

Background: Accurate cause of death (COD) certification is essential for public health planning and mortality statistics. Despite legal frameworks and WHO guidelines, documentation errors persist, particularly in North Indian hospitals, affecting data reliability and policy decisions.

Aim: This study aims to assess the accuracy, completeness, and common errors in COD certification, identify factors contributing to documentation deficiencies, and propose measures for improvement.

Methods: A retrospective, cross-sectional study was conducted at Shri Mata Vaishno Devi Institute of Medical Excellence (Medical College & Associated Hospital, SMVDNSH), a tertiary care hospital in North India, which is also a centre of excellence and teaching institute, analysing 1,147 COD certificates issued between March 2023 and March 2024. Certificates were assessed for accuracy based on ICD guidelines, and autopsy reports were reviewed to identify discrepancies. Errors were categorized into major and minor types and analyzed across hospital departments and certifier experience levels. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 17.

Result: Only 119 (10.38%) of the certificates were correctly filled. Major errors were found in 858 (74.80%) certificates, while minor errors were present in 810 (70.66%) certificates. A discrepancy between clinical and autopsy COD was observed in 112 (9.77%) of certificates. During Root cause analysis from the users’ perspective, it was found that out of 125 junior residents, 90 (72%) had made mistakes while filling the certificates, which reduced to 35 (28%) post-training. The highest errors occurred in the emergency (619; 54%), and 321 (28%) certificates were from the ICU.

Conclusion: Significant deficiencies in COD documentation highlight the need for targeted training, stricter adherence to ICD guidelines, and regular audits. Addressing these issues will enhance the accuracy of mortality data and improve public health planning.