(306) Audit of Death Declaration and Death Certificate Completion in a Public Sector Hospital: Pakistan

Introduction: Death certification is a responsibility of physicians that provides vital information for epidemiological, legal, and health policy purposes. However, many studies have shown that death certificates are often completed inaccurately or incompletely, leading to errors in mortality statistics and potential problems for the families of the deceased. The aim of this study is to assess the quality of death certificate completion skills and declaration of death among physicians and to identify the barriers.

Methods: A retrospective audit has been conducted, analyzing death certificates issued during a 6-month period: January 2023 to June 2023 within the PICU of Sindh Institute of Child Health & Neonatology. These were scrutinized in accordance with WHO recommendations for accuracy, completeness, and adherence. Data collected on demographic, administrative and medical variables.

Results: We reviewed 165 death certificates and consecutively the case files of those patients. From our assessment, we found many major and minor errors in our death certificates. 109 (65.6%) of the certificates that were issued did not have the mechanism of death listed with an underlying cause, competing causes were mentioned for 21(12.6%) of the cases. Among the minor errors, we did not observe any in the one criterion we assessed, time of death was stated for all 165 cases. For the declaration of death, there were interesting findings. Absence of breathing was not documented for 122 (74%) of the cases, absence of heartbeat was not documented for 113 (68.5%), absence of pulse was not documented for 116 (70.3%), response to painful stimulus was not documented for 141 (85.5%), flat line on the ECG was not documented for 70 (42.4%) of the cases.

Conclusions: There is immeasurable room for improvement when it comes to issuing death certificates and the declaration of death after observing the findings in our study. It would be very beneficial for these medical/healthcare personnel to acquire trainings and workshops in order to improve practices and avoid these errors. There can be a follow-up study to assess progress in the same setting after providing formal education and training and familiarizing people with official guidelines that are to be used in these regards.