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At least 19 recordsLinked to original sources

PubMed1996

Quality assurance of autopsy face sheet reporting, final autopsy report turnaround time, and autopsy rates: a College of American Pathologists Q-Probes study of 10003 autopsies from 418 institutions.

OBJECTIVE: To develop a multi-institutional reference database of autopsy practice and performance for quality improvement purposes. DESIGN: In 1990, participants in the Q-Probes quality improvement program of the College of American Pathologists (CAP) each retrospectively evaluated the 25 most recently completed consecutive autopsy reports and determined the number of deaths and autopsies that occurred in their institutions during 1989. SETTING: Hospital-based autopsies excluding forensic cases and stillborn infants. PARTICIPANTS: Four hundred ten institutions in the United States and eight institutions in Canada. MAIN OUTCOME MEASURES: Completeness of face sheet information contained in final autopsy reports, turnaround time for completion of final reports, and institutional autopsy rates. RESULTS: In the aggregate database of 10003 autopsies, the following six data items (from a total of 21) were present in 95% to 100% of the final autopsy reports in at least 85% of the participating institutions: institution where autopsy was performed, patient's name, patient's sex, autopsy number, autopsy date, and prosecter's name. The turnaround times for the final autopsy reports were as follows: 30 days or less in 47.6% of the cases, 31 to 60 days in 28.8%, and more than 60 days in 23.7%. A higher median percentage of autopsy final reports were completed in 30 days or less in institutions with the following characteristics: nonteaching (P < .004), no pathology residency program (P < .002), and rural location (P < .027). A lower number of autopsies performed in 1989 was associated with a higher median percentage of final reports completed in 30 days or less (P < .007). The aggregate autopsy rate for all participating institutions was 12.4%, and the median rate was 8.3%. Median autopsy rates for teaching institutions and institutions with pathology residency training programs were 15% and 19%, respectively. CONCLUSIONS: This multi-institutional study identified a core group of face sheet data items that were consistently present on final autopsy reports. However, the majority of the face sheet data items examined were inconsistently recorded. Approximately 75% of final autopsy report turnaround times were within the standard established by the Joint Commission on Accreditation of Healthcare Organizations. Nearly two thirds of the institutions reported autopsy rates for 1989 of 0% to 10%.

Autopsy↗

PubMed2000

Declining autopsy rate in a French hospital: physician's attitudes to the autopsy and use of autopsy material in research publications.

CONTEXT: Autopsy rates have been declining throughout the world, although preservation of the autopsy is considered a fundamental principle of medical care. In France, the 1994 bioethics law requires physicians to inform relatives before performing an autopsy. OBJECTIVE: To analyze the following factors that potentially influence hospital autopsy rates: legal constraints, autopsy reporting times, opinions of physicians requesting autopsies and pathologists regarding the usefulness of autopsy in patient care, and use of autopsy material in research publications. DESIGN: Record of the annual numbers of deaths and autopsies during a 10-year period (1988-1997). Record of the delays for transmission of final autopsy report to the requesting physician. Questionnaire analyzing the possible factors influencing autopsy rate. Categorization of articles published by pathologists according to the use of autopsy material. SETTING: A 1000-bed, university teaching hospital in the Paris, France, area. PARTICIPANTS: Questionnaire addressed to physicians, head nurses, and mortuary staff. RESULTS: A total of 1454 autopsies were reviewed. The autopsy rate declined from 15.4% in 1988 to 3.7% in 1997. This decline was marked after 1994 and tended to be slower for neurologic indications than for other indications. The final report had not been communicated within 180 days in 620 (42.6%) of 1454 autopsies. Fifty-five of 105 respondents considered that the bioethics law was one cause of the recent decrease of autopsy rate. Considering the contribution of autopsy to medical research, 94 (81%) of 116 articles dealing with central nervous system but only 28 (6%) of 464 articles dealing with other organs used autopsy-derived material. CONCLUSIONS: The 1994 bioethics law seems to contribute to the decline of autopsy. Inadequate delays for communicating autopsy results are frequent. Except for neuropathologists, autopsy is a minor source of research material.

Attitude of Health Personnel↗

PubMed2001

Factors affecting autopsy rates, autopsy request rates, and autopsy findings at a large academic medical center.

Autopsy rates continue to decline in the United States. To assess the impact of various objective factors (time of death, day of death, age at death, patient gender, clinical service, and length of hospital stay) on the autopsy request rate, autopsy rate, successful request rate, and percentage of cases in which the autopsy examination added to or altered the clinical assessment of the patient, we prospectively studied all hospital deaths at a major academic medical center for the 3-year period from 1996 through 1998. The autopsy rate decreases significantly with patient age, both because of a decreasing request rate and because family members are less likely to grant permission. An autopsy is less likely to be requested for deaths in the emergency department or on general surgery services and most likely to be requested for fetal, medicine, cardiothoracic surgery, and pediatric deaths. Families more commonly grant permission for autopsy on fetal deaths, pediatric deaths, and emergency department deaths. Forty percent of autopsies reveal significant information about the patient's death beyond what was known premortem. This is least frequent among the fetal deaths, but relatively constant for adults of all ages. Patients who die in the emergency department are most likely to have significant unexpected findings at autopsy. Increasing the request rate for adult patients who die in the emergency department and on the medicine services will result in the greatest increase in information learned from autopsy.

Age Distribution↗

PubMed1999

Practice guidelines for autopsy pathology: autopsy reporting. Autopsy Committee of the College of American Pathologists.

The Autopsy Committee of the College of American Pathologists has prepared this revised guideline to reflect changes that have occurred in the reporting of autopsies since the original guideline was published in February 1995. It is intended to be an instrument to assist pathologists in the reporting of autopsies. The guideline is to be regarded as being primarily an educational tool. Application of these recommendations on autopsy reporting is to be made on the basis of the judgment of the pathologist engaged in a specific case.

Autopsy↗

PubMed1995

[Acute pulmonary infections at autopsy. A study of clinical and macroscopic diagnoses at autopsy compared with microscopic autopsy findings].

The clinical diagnoses and gross diagnoses of acute pulmonary infections were investigated for 100 consecutively performed hospital autopsies, and the diagnoses were compared with the histological findings. We found 34 cases of pneumonia and one case of tuberculosis. Of these, 29 infections represented principal diagnoses, i.e. as causative of or contributive towards death. The predictive values, the sensitivities and specificities were estimated. The predictive value for gross diagnostics was low with a value of 42.9% against 58.8% for clinical diagnostics. The sensitivities for both clinical diagnostics and gross diagnostics were about 30% and the specificities about 85%. The study shows that sampling for histology from all pulmonary lobes is essential for correct autopsy diagnoses, either from areas that appear to be infected on gross examination or from the peripheral parts. Furthermore autopsy performance is still of great value for clinical diagnostics and for medical statistics.

Acute Disease↗

PubMed1995

Practice guidelines for autopsy pathology. Autopsy procedures for brain, spinal cord, and neuromuscular system. Autopsy Committee of the College of American Pathologists.

The Autopsy Committee of The College of American Pathologists has prepared this guideline in conjunction with representatives of other organizations to assist pathologists in autopsy procedures for brain, spinal cord, and neuromuscular system. The guideline is to be regarded as being primarily an educational tool. Application of these recommendations on autopsy reporting is to be made on the basis of the judgment of the pathologist engaged in a specific case.

Alzheimer Disease↗

PubMed1995

Practice guidelines for autopsy pathology. Autopsy reporting. Autopsy Committee of the College of American Pathologists.

The Autopsy Committee of the College of American Pathologists has prepared this guideline in conjunction with representatives of other organizations to assist pathologists in the reporting of autopsies. The guideline is to be regarded as being primarily an educational tool. Application of these recommendations on autopsy reporting is to be made on the basis of the judgment of the pathologist engaged in a specific case.

Abstracting and Indexing↗

PubMed1994

Practice guidelines for autopsy pathology. Autopsy performance. Autopsy Committee of the College of American Pathologists.

The Autopsy Committee of the College of American Pathologists has prepared this guideline in conjunction with representatives of other organizations to assist pathologists in the performance of autopsies. The guideline is to be regarded as being primarily an educational tool. Application of these recommendations on autopsy performance is to be made on the basis of the judgment of the pathologist engaged in a specific case.

Autopsy↗

PubMed1997

Practice guidelines for autopsy pathology: the perinatal and pediatric autopsy. Autopsy Committee of the College of American Pathologists.

The Autopsy Committee of the College of American Pathologists has prepared this guideline in conjunction with representatives of other organizations to assist pathologists in the reporting of perinatal and pediatric autopsies. The guideline is to be regarded as being primarily an educational tool. Application of these recommendations on autopsy reporting is to be made on the basis of the judgment of the pathologist engaged in a specific case.

Autopsy↗

PubMed2000

The autopsy lexicon: suggested headings for the autopsy report.

CONTEXT: Although standard autopsy texts and other publications discuss the general content of autopsy reports, and some provide examples of autopsy report formats, no publication to date has recommended specific headings for autopsy report organization. The College of American Pathologists Autopsy Committee decided it would be helpful to provide suggestions for autopsy report headings to foster more standardized autopsy reporting, to facilitate review of reports by third parties, and to facilitate searches of electronically stored autopsy reports. OBJECTIVES: To create a model document (named the Autopsy Lexicon), which defines standard categories of information that are useful to include in autopsy reports; to offer specific wording for the headings of various sections of the report; and to explain the rationale for including the various items of information and headings. PARTICIPANTS AND METHODS: The members of the Autopsy Committee of the College of American Pathologists prepared the document by reviewing various examples of autopsy report formats, identifying specific categories of information usually contained in such reports, and developing wording for various sections of the autopsy report that would contain specific information. A draft was submitted to 45 members (including 12 forensic pathologists) of the College of American Pathologists for review, comment, and reality testing. Reviewers included pathologists from both community and academic settings. Comments of reviewers were incorporated to the extent possible. RESULTS: The Autopsy Lexicon was prepared and is a model document for autopsy pathologists who wish to define an autopsy template of headings for consistent organization of autopsy reports. CONCLUSIONS: The Autopsy Lexicon is available to foster more uniform reporting of autopsy information, which may facilitate review of autopsy reports and retrieval of information from electronically stored autopsy reports.

Autopsy↗

PubMed1996

Quality assurance of autopsy permit form information, timeliness of performance, and issuance of preliminary report. A College of American Pathologists Q-Probes study of 5434 autopsies from 452 institutions.

OBJECTIVE: To develop a multi-institutional reference database of autopsy practices and performance for quality improvement purposes. DESIGN: In 1992, participants in the Q-Probes quality improvement program of the College of American Pathologists each prospectively evaluated consecutive autopsies performed over a 6-month period, up to a maximum of 20 autopsies per institution. SETTING: Hospital-based autopsies, excluding forensic cases and stillborn infants. PARTICIPANTS: Four hundred forty-nine North American institutions and three Australian laboratories. MAIN OUTCOME MEASURES: Completeness of information contained on autopsy permit forms, timeliness of autopsy performance between patients' deaths and autopsy prosections, and turnaround time of preliminary autopsy reports. RESULTS: In the aggregate database of 5434 autopsy cases, 7 of 11 selected data items were consistently present on autopsy permit forms in 80% of the participating institutions. The median percentage of autopsies in which permission was given for an unrestricted (complete) autopsy was 71%. The following median time intervals were obtained: time of the patient's death to time the autopsy permission was received, 5 hours, 23 minutes; time the autopsy permission was received to time the prosection was started, 3 hours, 30 minutes; and time of the patient's death to time the prosection was started, 14 hours, 52 minutes. Differences were observed in some time intervals when the participating institutions were grouped by reported demographic characteristics. Preliminary reports were completed in 2 days or less in 80.9% of the autopsies. CONCLUSIONS: Through this multi-institutional study, we have documented a consistent core of autopsy permit form information requested and a wide range of time intervals elapsed between the patients' deaths and autopsy performance. We have also established that the majority of participating institutions meet the College of American Pathologists' laboratory accreditation standard of providing a documented preliminary report of the gross pathologic diagnoses submitted to the attending physicians and institutional record within 2 working days following autopsy completion.

Autopsy↗

PubMed2003

[The autopsy law of Hamburg from February 9, 2000--changing autopsy rates in departments of pathology in Hamburg].

The decline of the autopsy rate in institutes for pathology in Germany is a reason for growing concern. One reason for the restrained activity in performing autopsies might be uncertainty about the legal position concerning the admissibility of so-called clinical or scientific autopsies. Whereas a legal basis for different kinds of autopsies does exist for quite some time (i.e. code of criminal procedure, epidemic law etc.), such statutory rulings have been lacking for clinical or scientific autopsies. Following Berlin and Bremen, in 2000 Hamburg introduced a law for the regulation of scientific autopsies. This autopsy law differentiates between clinical, medicolegal (not on public prosecutor's order), and anatomical autopsies. It arranges aspects of legality of, consent in, order of, and implementation of the autopsy. A survey among clinical pathologists in Hamburg clarifies the drop in the autopsy rate since the last decades until today. The colleagues were also asked to point out their opinion about the reasons for the dropping autopsy rate and to state their experience with the new autopsy law.

Autopsy↗

PubMed2002

Ultrasonographic autopsy (echopsy): a new autopsy technique.

Autopsy has been one of the most important techniques for the development of modern medicine, mainly during the nineteenth century and the first half of last century. However, in the last few years, the number of autopsies performed in hospitals has dramatically decreased all over the world. This loss of interest can be attributed both to important advances in other diagnostic and therapeutic techniques and to the fear of malpractice suits. Several groups have tried to overcome this problem, developing different autopsy techniques, one of which is needle autopsy. Most authors using this technique have acknowledged that it is difficult to obtain material from certain organs and lesions, which makes its diagnostic reliability worse than that of conventional autopsy. To overcome this drawback, our team has recently developed a modification of needle autopsy, called ultrasonographic autopsy or echopsy, in which samples are obtained under ultrasonographic control. We report the results of the first 100 cases of echopsy performed in our hospital, comparing this technique with conventional autopsy performed on all the corpses. The concordance rate for the cause of death and the main pathological diagnosis between echopsy and classical autopsy was 83% in our series, which makes echopsy a feasible and reliable alternative to conventional autopsy in cases in which families refuse to give their consent for classical autopsy or in cases of infectious diseases.

Adult↗

PubMed2002

Research for improving the autopsy rate for infant death--medical economic assessment of the forensic autopsy system in Japan.

The rate at which autopsies are performed in Japan for cases of infant death is not adequate for diagnosing sudden infant death syndrome (SIDS). In Japan, it will be necessary to increase the autopsy rate at the time of infant deaths in order to improve the certainty of diagnosing SIDS and improving the accuracy of determining the cause of death with respect to infant death. The objective of this research is to provide basic documentation required for administrative implementation of this objective. In Japan, the Medical Examiner System and its related Approved Autopsy System are not deployed nationwide. The estimated budget in the case of deploying the Medical Examiner System nationwide for the purpose of improving the infant death autopsy rate is in excess of 5 trillion yen, and that in the case of deploying the Approved Autopsy System nationwide is estimated at roughly 130 million US dollars. However, since the rate of autopsies performed for SIDS has not changed following the implementation of approved autopsies, the efficacy of the Approved Autopsy System has come to be viewed questionably. In addition, it is also necessary to enact legislation that mandates the conducting of autopsies for all cases of infant death as is done in Scandinavia. The required cost in the case of performing autopsies for all cases of abnormal infant death is estimated at 200,000-700,000 US dollars and is considered to be within a range that could be implemented through local government regulations. In addition, the cost per body of an autopsy performed at the State Crime Laboratory in the State of Arkansas in the US in 1999 was about 6000 US dollars. In contrast, the same cost at the Tokyo Medical Examiner Office is much less at only about 4000 US dollars.

Autopsy↗

PubMed2001

Declining clinical autopsy rates versus increasing medicolegal autopsy rates in Halifax, Nova Scotia.

The downward trend in the rate of clinical autopsies has been extensively documented in the literature. This decline is of concern when the benefits of the clinical autopsy are considered. In contrast, the rate of medicolegal autopsies has not been studied in such detail. What little reference there is to medicolegal autopsy rates suggests an absence of the same downward trend. A retrospective review of autopsy data over a 13-year period from the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, and from the Office of the Chief Medical Examiner of Nova Scotia was conducted. This review showed a difference between the rates of clinical and medicolegal autopsies for the metro Halifax area. The clinical autopsy rate was consistently less than 30% and declined to 15% in 1999, while the medicolegal autopsy rate was consistently greater than 40% and rose to 62% in 1999. The literature proposes many reasons for the decline in the clinical autopsy rate, but none for this difference between rates. The explanation proposed here is the changing and currently uncertain purpose of the clinical autopsy versus the clear, and consistent over time, purpose of the medicolegal autopsy.

Autopsy↗

PubMed1986

[Significance of autopsy. Continuous evaluation of autopsy findings by internists].

To continuously monitor the impact of autopsy results, a short questionnaire was forwarded with each list of autopsy diagnoses to the clinician who had requested the autopsy. This continuous feedback between clinician and pathologist reveals unsolved problems and provides the opportunity for their interdisciplinary evaluation. The 1188 autopsies were done from 1980 to 1984 at the Institute of Pathology for the Medical Clinic, Cantonal Hospital, Lucerne, an acute-care medical teaching hospital department containing about 200 beds. The autopsy rate was 52% for in-hospital deaths. The clinician deemed that about 9/10 of all autopsies had confirmed his diagnosis. About 3/4 of all autopsies disclosed previously unknown and clinically important findings. Major discrepancies between clinical diagnosis and autopsy findings were noted in about 10% of all autopsies. Further, in approximately 1/10 of all autopsies the findings were considered to be of potential therapeutic relevance had they been known before death. The results confirm the relevance of autopsy for the practice of controlled clinical medicine based on objective criteria.

Autopsy↗

PubMed1995

Medical students' attitudes toward autopsy. How does experience with autopsies influence opinion?

OBJECTIVE: To assess the attitudes of medical students and compare them with those of resident physicians and the public. DESIGN: A survey of medical students during the term following their pathology course. Data from this survey were compared with data from previous studies conducted with resident physicians and the public. SETTING: The Medical School, Uppsala University, Sweden. PARTICIPANTS: Three cohorts of third-year medical students. MAIN OUTCOME MEASURES: (1) Evaluation of autopsy activities, (2) attitudes toward having an autopsy performed on oneself and a relative, and (3) discomfort reactions at the thought of having an autopsy performed on oneself. RESULTS: The 129 respondents (response rate 75%) had a high appreciation of the autopsy and 90% accepted being autopsied themselves. The majority thought the autopsies were respectfully performed, but 75% still felt uneasy when confronted with an autopsy or when contemplating one on themselves. The more discomfort felt, the less willing respondents were to be autopsied and the fewer the reasons were given for agreeing to an autopsy. The students and the public had very similar response patterns. Both groups were more positive toward their own autopsy than were the residents. CONCLUSIONS: Immediately after a course in pathology the usefulness of autopsies stands out clearly, but it seems that this opinion subsides when students become qualified doctors and feelings of uneasiness take over. The similarities between the students and the public were striking, but there were some differences that were obviously attributable to medical training.

Attitude of Health Personnel↗

PubMed1999

The autopsy as a performance measurement tool--diagnostic discrepancies and unresolved clinical questions: a College of American Pathologists Q-Probes study of 2479 autopsies from 248 institutions.

OBJECTIVE: To develop a multi-institutional reference database for quality improvement purposes using the autopsy to define clinical diagnostic discrepancies and resolve clinical questions. DESIGN: Using the College of American Pathologists Q-Probes format, institutions prospectively assessed a maximum of 15 consecutive autopsies each, excluding forensic cases and stillborn infants, conducted over a 6-month period. They documented answers to clinical questions provided at autopsy and classified unexpected disease diagnoses according to a standardized system. SETTING AND PARTICIPANTS: Hospital-based autopsies performed at 248 institutions participating in the 1993 College of American Pathologists Q-Probes Quality Improvement Program. MAIN OUTCOME MEASURES: Percentages of clinical questions resolved by the autopsy and percentage of autopsies with unexpected findings of graded clinical impact. RESULTS: In the aggregate database of 6427 questions from 2479 autopsies, overall 93.0% were answered by the autopsy. The 3 most common question categories were (1) identify pathology to account for clinical signs or symptoms (28.0%); (2) establish the cause of death (21.0%); and (3) confirm a clinical diagnosis (19.0%). At least one major unexpected disease finding that contributed to the patient's death was discovered in 39.7% of the total number of autopsies. There were no differences in the percentages of autopsies with these major unexpected findings when the data were stratified by institutional demographics or decedent characteristics. CONCLUSION: This multi-institutional study underscores the clinical relevance of postmortem examination in current medical practice by consistently providing answers to unresolved clinical questions and frequently revealing major unexpected findings that contributed to the patient's death. It is our strong belief that this postmortem-derived clinicopathologic information is a key indicator of effectiveness of care. Integration of this information into institutional quality improvement programs will improve system processes and clinician performance.

Autopsy↗