MEDICAL CERTIFICATION OF Cause of death THE ROLE OF THE REVIEW COMMITTEE Samoa 2017

The Medical Review Committee It is good practice for a medical review committee to be held on a routine basis. The purpose of this committee is threefold – To evaluate cases where the sequence of events is unclear and come to a better understanding of what happened in these events through peer contributions and review To identify what steps could have been taken to potentially avoid the death occurring and modify procedures and health programs accordingly To provide an opportunity for ongoing CME and assist doctors to stay up to date. The committee should also consider the medical certificate – and whether this was completed accurately. Errors in the certificate should be formally documented and brought to the attention of the HIS team to update the record Review committees are in place in many hospitals but rarely include a review of the certificate.

Deaths that should be reviewed Deaths that should be considered for review include: Maternal deaths Neonatal deaths (especially those in hospital) Deaths following a medical procedure (infection control review) Complex cases where there is uncertainty regarding the diagnosis (especially for premature deaths) Deaths that occur as part of an outbreak or emergency Other deaths which demonstrate a learning outcome or issue for colleagues (for example deaths in patients referred overseas for further treatment). Note – premature deaths are those prior to “old age” not just in children.

Setting up a routine review Scheduled as part of the routine doctors meetings, however specific cases may be reviewed by existing standing committees (maternal cases, child health etc) Responsibility for presenting a case is often rotational, but allocated by the medical supervisor It may be useful to have other health staff engaged in the discussion including: nurses, public health program staff etc, depending on the case. A review may consist of: A short presentation of the case, including the medical history, sequence of events that led to the death, and outcome (including key decisions or uncertainties) by the attending doctors An open discussion, usually led by the doctor presenting their case; and A review of the medical certificate of death.

Information that should be available at the review meeting The review meeting should have the following information on hand: Medical record of the patient, including history, and any scans or diagnostic tests The medical certificate of death, in its original form (ie as it appears on the certificate, rather than an extract from the digital file) Any VA instrument, if completed. NOTE: You may need to use de-identified extracts of this information to preserve patient privacy. These should be prepared in advance of the meeting, and is good practice as a standard approach A guide to the correct completion of the medical certificate – such as the D4H assessment tool (provided as a handout).

Reviewing the Certificate The meeting should consider: If the cause of death sequence as certified reflects the events as presented (i.e. what was the true cause of death) If the certificate was completed correctly based on the ICD rules (ie was there only one cause per line in part 1, was the sequence in the right order, and was all the required information provided). If a correction to the record should be considered based on the above (and if so – notified to HIS team) If the death should be referred by the medical supervisor for further investigation by the police or court.

Reviewing the Certificate The meeting should consider: If the cause of death sequence as certified reflects the events as presented (i.e. what was the true cause of death) If the certificate was completed correctly based on the ICD rules (ie was there only one cause per line in part 1, was the sequence in the right order, and was all the required information provided). If a correction to the record should be considered based on the above (and if so – notified to HIS team) If the death should be referred by the medical supervisor for further investigation by the police or court.

Discussion In a small group – think of one case that resulted in a death that would fit into one of the categories outlined. Without disclosing any identifiable information – outline the sequence of events to your colleagues and determine what information should have been completed on the medical certificate for this case. Complete this information (excluding names) on the sample certificate provided. Note – the completed certificates should be reviewed to ensure they are completed in line with ICD rules and have sufficient information. Discuss with each group (or whole group depending on time and content).

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