RESUMO
BACKGROUND: Deaths at Akershus University Hospital were systematically reviewed to evaluate the quality of death certificates and to improve reporting of deaths by unnatural causes. MATERIAL AND METHOD: Death certificates and medical records from the 496 patients who died at Akershus University Hospital in the period 1 May-31 December 2008 (8 months), were reviewed prospectively. Doctors were contacted when death certificates had an illogical set-up, when important clinical findings were not reported, and upon suspicion of unnatural death or a lethal adverse drug reaction. For comparison, 134 deaths that occurred in March 2007 and March 2008 were evaluated retrospectively. RESULTS: 27 % of death certificates in the control period and 20 % of those in the project period had either a combination of incorrect content and a logical set-up or incorrect content and an illogical set-up. In the project period, the percentage of death certificates with logical set-ups increased from 64 % to 76 % (p = 0.047) and the percentage of correct set-ups increased from 76 % to 84 % (p = 0.029). The percentage of deaths by unnatural causes was 12 % in the project period and 7 % in the control periods; lethal adverse drug reactions comprised 5 % of deaths in the project period and 7 % of those in the control periods. INTERPRETATION: All deaths should be reviewed to increase accuracy of cause-of-death statistics and to adhere to reporting routines founded in Norwegian law. Follow-up of deaths in hospitals should be centralized; a consultant pathologist or a physician with similar competence should be responsible. Continuous feedback to clinicians will increase the quality of death certificates and raise awareness of law-based reporting routines.