Completing Death Certificates in Hospital Setting: What Can Go Wrong, Will Go Wrong

Cécile M Woudenberg-van den Broek; Annemiek M Vuurens; Paul L P Brand; Walther N K A van Mook; Ralph K L So; Wilma L J M Duijst-Heesters

doi:10.1177/19253621251343662

Completing Death Certificates in Hospital Setting: What Can Go Wrong, Will Go Wrong

Acad Forensic Pathol. 2025 May 27:19253621251343662. doi: 10.1177/19253621251343662. Online ahead of print.

Authors

Cécile M Woudenberg-van den Broek¹, Annemiek M Vuurens², Paul L P Brand^{3

4}, Walther N K A van Mook^{5

6

7}, Ralph K L So⁸, Wilma L J M Duijst-Heesters⁹

Affiliations

¹ Department of Criminal Law and Criminology, Faculty of Law, Maastricht University Role: A, B, C, D, E, 1.
² Netherlands School of Public and Occupational Health Role: B, C, D, E.
³ Isala Academy, Department of Medical Education and Faculty Development, Isala Hospital.
⁴ Wenckebach Institute for Medical Education, University of Groningen and University Medical Centre Groningen Role: B, C, D, E, 5, 6.
⁵ Department of Intensive Care Medicine, Maastricht University Medical Center.
⁶ School of Health Professions Education (SHE), Maastricht University.
⁷ Academy for Postgraduate Training, Maastricht University Medical Center+ Role: B, C, D, E, 5, 6.
⁸ Department of Intensive Care, Albert Schweitzer hospita Role: B, C, D, E, 5, 6.
⁹ Department of Criminal Law and Criminology, Faculty of Law, Maastricht University Role: A, B, C, D, E, 4, 6.

Abstract

Introduction: Of the 170 000 death certificates filled out annually in the Netherlands, approximately a quarter is completed by a hospital physician. From a legal and statistical point of view, it is important that the legally required forms, that is the certificate of death (CD), the medical certificate of cause of death (MCCD), and the envelope of the MCCD used for medical secrecy reasons are filled out correctly (ie, according to law) and accurately (ie, cause of death in line with medical files).

Materials and methods: For this study, 517 CDs and MCCDs were collected from three hospitals over a 5-month period. The CDs and MCCDs were analyzed to determine to what extent they met the formal (correctly, according to law) and material (accuracy of the cause of death as compared to medical file information) requirements.

Results: In only 34 cases (6.7%) the hospital physicians fulfilled the formal requirements for completing both forms and the envelope of the MCCD. Sixteen cases were issued as natural deaths, although they were unnatural deaths. In 55 cases (11%) a phenomenon associated with death such as "no circulation" or "no breathing" was recorded as cause of death. Only 23 cases (4.5%) met the requirements of an accurate cause of death and correct completion of forms and envelope.

Discussion: Hospital physicians rarely met the formal requirements when filling out the forms and corresponding envelope. Furthermore, the accuracy of the reported cause of death reveals potential for improvement.

Conclusion: Correctness and accuracy in these forms are important not only from a legally administrative and criminal law point of view, but also for the robustness of public health epidemiology and the related funding of prevention of the established causes of death.

Keywords: Cause of death; Death certification; Forensic medicine; Forensic pathology; Hospital physicians; Medical certificate of cause of death (MCCD).