Cause of Death Quality

As a part of the ongoing effort to improve cause of death documentation and reporting, we have developed several resources and training materials for medical facilities.

Instructions: Cause of Death

Physicians and medical staff completing death certificates may need a quick review of the concepts of cause of death documentation. The Cause of Death Instructions describes basic steps to completing the Cause of Death section on the death certificate. The Cause of Death Training PowerPoint (PPT) provides a more detailed review of cause of death certification, including case examples.

Death Query Process

We will soon begin to query physicians and medical certifiers for additional information when the cause of death lacks appropriate detail. The Department of Health will send a notification that a query has been initiated. Following the instructions of the query prompt, the physician will submit a Cause of Death Query Amendment (PDF) in the Electronic Death Registration System (EDRS) to update the Cause of Death with additional detail. Response to these queries is essential in improving the quality of cause of death data, evaluating the leading causes of death and the magnitude of certain health outcomes within our communities, and creating effective public health policy. Facilities will be notified in advance of death query activities.

Required eLearning training course

We require all users of the Electronic Death Registration System to complete an eLearning course. This requirement was implemented in response to evidence of poor quality documentation and recognition of a lack of training on this topic in New York City. The course teaches physicians and medical facility staff who complete death certificates how to accurately complete the Cause of Death section, when to refer a case to the Office of Chief Medical Examiner, and the importance of accurate cause of death data that informs public health statistics, programs, and policies.

Death Worksheet

The physician must have access to the decedent's medical chart when determining the cause of death for death registration. The Death Worksheet (PDF), allows the physical transfer of cause of death information from the location of the death/medical chart to an EDRS workstation. The attached Death Worksheet is optional. The worksheet must be completed by a physician and may not be used for death registration. Use of the Death Worksheet is encouraged when the cause of death is documented sometime after the death, when the medical chart is not usually available at the EDRS workstation, and/or when the certifying physician was not the decedent's attending physician.

Death Newsletters

The Quality Improvement Unit of the Office of Vital Statistics is dedicated to improving the quality of vital event data by providing education and training to data providers. The newsletter titled 'Cremation Clearance: Requirements for Medical Examiner Approval' (PDF) is the first in a series of quality improvement newsletters that will be distributed to hospitals and facilities that report deaths.

Other cause of death resources

• A pocket reference (PDF) to assist with filling out death certificates and improve accuracy in cause of death reporting. Physicians have found this helpful to carry with them for when they need to complete the cause of death. Please contact the Quality Improvement Unit in the Office of Vital Statistics at VitalQI@health.nyc.gov to request laminated pocketcards for your medical staff.
• Instructions (eCHI) from the Health Department to improve cause of death reporting, including information on health code requirements, cause-of-death checks in EVERS, medical examiner review and helpful examples.
• A poster (PDF) that instructs physicians on how to complete the Cause of Death section of the death certificate. This may be printed and posted in areas of medical facilities where physicians complete the cause of death and used as a tool to train new staff.
• The National Association of Medical Examiners online tutorial , which teaches the basic principles of writing cause of death statements.