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Enhancing autopsy performance and reporting. A system for a 5-day completion time
1Department of Pathology, St Joseph Hospital, Creighton University School of Medicine, Omaha, Nebraska, USA.
Objective:
To develop a system for enhancing the performance and reporting of autopsies in an effective and clinically useful manner.
Design:
Twelve steps were defined as essential for the completion of the autopsy. Each step of the process was evaluated for usefulness and effectiveness.
Setting:
Autopsies performed in a university hospital from 1992 through 1994.
Participants:
Pathology residents and staff, clinicians, and clinical team house staff.
Intervention:
Participants followed the 12-step process, with emphasis on involving the clinical team in the interview, prosection, and final rounds. The final rounds conference was designated a working conference, where the perfused-fixed brain was cut, histologic sections of the case were submitted, and the provisional diagnosis was written with the clinicians. A next-day microscopic slide review session was scheduled to "sign out" the case. Establishing a philosophy of status equal to all other department functions facilitated implementation.
Main Outcome Measure:
All autopsies performed for a period of 3 years (2 retrospective and 1 prospective) were included.
Results:
The autopsy completion time was reduced from a mean of 57 days (range 7 to 174) in 1992 to 4.8 days (range 1 to 16) in 1994.
Conclusion:
The autopsy completion time was reduced, increasing its usefulness for teaching and quality assurance. Relationships with the clinical staff were enhanced with consultation-style final reports. Enthusiasm for, and satisfaction with, the new process was expressed by clinicians, pathology staff, residents, and technical support staff.