The work of our Death Certification and Review Service (DCRS) has a direct impact on the people who have experienced the death of a loved one, helping to provide answers and clarity to aid the bereavement process. Dr George Fernie, our Senior Medical Reviewer, explains the benefits to the public of the work of DCRS.
The death of a loved one can be a distressing and complicated time for family and friends. No matter how prepared you might be for an individual’s passing, there is always so much to do, a great deal to process and so many questions that loved ones seek answers to.
The death certificate is that all-important legal document, written by the treating doctor, and provides clarity as to the cause of death. If the deceased had other health conditions or a series of medical events leading up to their death, an accurate certificate can provide answers that can help people process what has happened.
DCRS – the vital service behind the scenes
The Death Certification Review Service (DCRS) fulfils a vital role that happens largely behind the scenes – a function that most families and friends of people who have died will be completely unaware of. In a way, that’s a very good thing. We always aim to be as unobtrusive as possible, so that we don’t affect burial or cremation plans.
In essence, our role is to ensure that death certificates are completed accurately by checking a random sample of certificates before they are issued, providing advice to doctors who have questions about how to complete a certificate, and helping ensure accurate data of information on public health and the main causes of mortality in Scotland. Moreover, we work with both junior and experienced doctors to provide training and opportunities for them to learn and improve; thus ensuring that more and more families are clear on the cause of death of their loved one.
Standard of accuracy continues to improve
As we publish our latest annual report for 2021/22, we’re delighted to say that the standard of accuracy in how doctors are completing death certificates continues to improve. The monthly percentage of randomly-selected death certificates found to be ‘not in order’ – meaning that we have requested changes or clarification – has seen a sustained improvement each year to a current median of 21.5%. Of the certificates we deemed were ‘not in order’, 48% were due to the cause of death being too vague. ‘Too vague’ can mean failing to specify the location and type of cancers or strokes. This information gives consistency in recording causes of death in Scotland that will help resources to be directed to where they best need to be. Administrative errors like spelling mistakes, use of abbreviations and failing to sign the certificate, were other reasons for DCRS asking for improvements to the certificate which was issued.
But doctors also get in touch with us for advice, and we’re available to them 365 days a year, which is especially important for particular faith groups. In 2021/22, we dealt with 2,279 calls. The majority of calls (81.8%) were from doctors seeking clinical advice on how to represent a death on a death certificate.
Repatriation and deaths abroad
We’re also responsible for approving burial or cremation in Scotland of people who have died abroad and want to be repatriated to Scotland.
In 2021/22, the service received 84 repatriation requests. All were approved. One family requested a post mortem which was also granted.
Review requests from the public
Members of the public can request a review of a death certificate, as well as registrars being able to refer a death certificate to DCRS service for review if they feel the certificate is not accurate.
We will then carry out a Level 2 more detailed review, if the death has not previously been reviewed by us, or the death has not already been reported to the Procurator Fiscal. Last year we carried out 13 such reviews, of which 6 were found to require a change and 3 required reporting to the Procurator Fiscal. One was declined as the death had previously been considered by the Procurator Fiscal.
Potential challenges ahead
Year on year we have seen the amount of time within which our reviews take place getting shorter and we are aware this winter period, with greater pressure on the NHS, completing reviews as quickly may be challenging. In 2021/22, our average time to complete a level 1 review was less than 4 hours, however 217 reviews took longer than our agreed 8 hours timescale, with 187 due to difficulties reaching the certifying doctor to carry out the review. Deaths cannot be registered until DCRS complete the review and delays in death certificates being issued, can impact on burial or cremation plans. We will do all that we can over the coming months to minimise the disruption to loved ones at an already difficult time.
The year ahead
Over the year ahead we will continue to look to improve the service we provide. By doing this, we know that families and loved ones across Scotland can get greater certainty around the cause of death of their loved one; thus aiding the grieving process and providing a key answer to a question that so often accompanies death.
Read the latest DCRS Annual Report for 2021/22.
George Fernie is a Senior Medical Reviewer at Healthcare Improvement Scotland.