[The necrology meeting as an instrument for quality of care improvement; experiences at the Ikazia Hospital, 1990-2000].

The death of a patient highlights the demand for quality of care. Publication of hospital mortality figures risks incorrect interpretation and does not lead to an improvement in care. However, an above-average hospital mortality rate can be a sign of poor quality in a particular aspect of care. In the necrology meeting, the evaluation of this quality must take place with critical self-reflection, to detect opportunities by which to improve the quality of care. Quantitative data to support the necrology meeting are necessary to improve the quality. This requires systematic registration and a valid code system. In the Department of Surgery at the Ikazia Hospital Rotterdam, the Netherlands, an ABC coding system is used which indicates whether the patient died of the disease or complications, whether the death was influenced by identifiable shortcomings in the diagnostic work-up, surgical treatment or non-surgical treatment, or whether no shortcoming could be identified, and whether autopsy was carried out or refused. A more detailed registration model is developed which may be more useful in future necrology meetings and in the evaluation of these meetings.