Hospital Autopsy Quality Control and Assurance: The London Health Sciences Centre Experience
Rebekah Jacques, Michael Shkrum. London Health Sciences Centre (University of Western Ontario), London, ON, Canada
Background: There are few guidelines that exist for ensuring hospital autopsy quality assurance and control. This study presents a comprehensive assessment of quality assurance in the pre-analytic, analytic and post-analytic phases in the completion of a hospital autopsy report. Our goal is to make recommendations for enhancing performance and reporting of autopsies in an effective and clinically useful manner.
Design: We performed a retrospective review of all hospital autopsies performed from January 1, 2009 to December 31, 2009 at our Centre. We examined the authorization for autopsy consent forms, medical records, autopsy photographs, glass slide preparation times, autopsy reports including ancillary studies, consultation forms by clinicians and pathologists, autopsy checklists and Adverse Event Management System (AEMS) reports. The pre-analytic phase assessed autopsy consent form issues and received clinical consultation forms. The analytic phase assessed resident involvement, intradepartmental consultation(s), microscopic section codes, clinical pathologic correlation and ancillary investigations. The post-analytic phase examined completed autopsy checklists, AEMS reports and the response to clinical question(s). Turnaround time parameters included: completion of provisional anatomical diagnoses and the final report.
Results: There were 166 autopsies reviewed, one case was excluded in accordance with consent restrictions. In the pre-analytic phase, there were 34 consent issues with half of these due to clarification of the next of kin and autopsy procedure restrictions. In the analytic phase, 67 (41%) reports did not have a complete microscopic section code and 27 (16%) reports were without clinical pathologic correlations. Photography was done in 60% of cases; however, this was mentioned in 2 reports. In 4 of the cases there was an error in the photo's ruler label. In the post-analytic phase there were 6 corrected reports due to formatting or typo/grammar errors. The average sign-out times for the provisional anatomical diagnoses and case completion were 5 and 146 days, respectively.
Conclusions: Overall, the completion times for provisional anatomical diagnoses and final reports did not conform to Pathologists' professional association guidelines. There were a number of consent issues that were identified at the time of autopsy but not reported to risk management. Recommendations from this study include: creating a user-friendly autopsy consent form, guidelines for and monitoring of turnaround time and in-depth audit/peer review of randomly selected autopsies.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 1, Monday Morning