Our Medical Reviewer, George Fernie, explains how our Death Certification Review Service (DCRS) has helped the national response to the pandemic by advising doctors on the accurate recording of deaths.

In many respects, this year’s annual report has been difficult to write. It has felt slightly uncomfortable to be looking to celebrate how the Death Certification Review Service (DCRS) has been supporting the pandemic, when the reality is that we’re helping to improve the accurate recording of deaths which we sincerely wished had never needed to be reported. 

However, one thing that we shouldn’t shy away from is the importance of DCRS in being able to support the response to the pandemic in meaningful ways.

It has been vital that death certificates have been completed correctly and that doctors have been given the proper advice to know how to record COVID-19, especially when there can be a range of other co-morbidities that may have impacted on an individual’s death. The evidence tells us that we’ve risen to the challenge and carried out our task effectively for the service.

The importance of improvements

DCRS sits within Healthcare Improvement Scotland. As a consequence, it’s right that improvement is at the heart of what our service does.

I’m proud to say that DCRS has seen sustained year-on-year improvement in the quality and accuracy of Medical Certificates of Cause of Death (MCCDs), and the progress achieved appears to have been maintained as we start to exit the worst of this unpredicted virus.

We continue to meet our legislative requirements to improve the quality and accuracy of MCCDs, giving the public confidence in the death registration process in Scotland; to inform public health information about causes of death in Scotland, supporting consistency in recording that will help resources to be directed to the best areas in a more timely way. In addition, we’ve seen continued improvement in the number of ‘not in order’ certificates across all NHS boards – despite the significant additional pressures placed upon certifying doctors and the team of medical reviewers during the pandemic especially. Moreover, all advance registration applications have been undertaken within 2 hours, which minimises any additional stress that might be caused to loved ones as a consequence of knowing that a review of the paperwork was to be carried out.

These improvements are down to the hard work and dedication of the DCRS team, but also to the doctors across the breadth of the country to show commitment to making sure that death certificates are accurate and meaningful.

Fulfilling our commitments

Each year we set goals for key areas that we wish to improve. Last year was no different, even though we were in the midst of the pandemic.

On top of the goals we set, in July we took the opportunity to reflect on our response to the pandemic and carried out an After Action Review which helped us to be prepared and positively respond to the second wave. We responded well, indeed, we identified why there was a difference between death rates from COVID-19 diagnosed clinically and those where there was a positive polymerase chain reaction (PCR) swab, taking into account a known ‘false-negative’ rate. In addition, we highlighted nosocomial (hospital acquired) infections and successfully used the Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) framework to categorise these. Furthermore, we worked with Scottish Fatalities Injuries Unit (SFIU) and the COVID Death Investigation team (CDIT) to ensure accuracy and promote public reassurance.

Unexpected developments

Although we would not have planned to do so in a pandemic situation, through necessity the service migrated IT systems and relocated staff (although at the moment the full team continue to work from home). Within seven months we have successfully introduced a new electronic case management and telephony system which has allowed the service to work with greater efficiency, in a more focused manner and benefits all stakeholders in the death registration process.

The pandemic and our team

Like the rest of society, the staff of DCRS experienced all the varied consequences of COVID-19 where many of us were tested for the virus, a number contracted the virus and, some like myself, lost a frail family member, all whilst viewing real-time data of the deaths that were occurring in front of us. Whilst this was nothing like the impact on those in the frontline of the NHS, we have had to learn to live very differently in both our personal and professional lives. We were fortunate enough to come through this experience physically unscathed as a team, but are very much aware of the consequences due to our direct knowledge of what had happened.

I cannot thank my team enough for pulling together during an incredibly difficult time where I believe we made a meaningful contribution to the NHS in Scotland – their commitment and sensitivity at a time of national emergency was outstanding.

George Fernie is Senior Medical Reviewer with Healthcare Improvement Scotland.

More information

Read the latest Death Certification Review Service Annual Report.