The Autopsy ProcessQuality Improvement and Systems

Based PracticeMelissa Maricondo, DO, MPH

June 2, 2009

M & M

• Case Based Presentation of the Autopsy Process – January 2009

• Patient expired, family wanted an autopsy, but autopsy did not get done

• Break in the system between the housestaff, MIS, medical records, and pathology department

Questions Raised• Whose responsibility is it to see through an autopsy request? • What is Temple University Hospital’s policy regarding autopsy

request?– Primary team– Autopsy Service/Department of Pathology and Laboratory Med.– Medical records

• The role of the MIS system expiration order, including autopsy request?

• How to interpret the Death Certificate wording of autopsy questions?

• How long does family have to make autopsy request?• Autopsy process from a pathology perspective?

Interdepartmental Communication

• Departments Involved– Pathology– Medical Records– Risk Management– Legal Counsel– Internal Medicine Administration and Housestaff

Follow Up Resident Presentation of Autopsy Process – From Death to

DisclosureMay 2009

• MIS - “Autopsy pending option” (To get this you first have to answer “yes” to meets autopsy criteria)

• Autopsy Process – Pathology perspective– Does physician have to offer autopsy by law? - No– Cost of an autopsy to family? - $0– Does autopsy interfere with funeral? – No– Details of procedure outlined to residents

• Autopsy Consent Process– Paperwork– What to do if family cannot be reached

• Role of Medical Records in closing the loop• Autopsy Report• Disclosure

– Whose responsibility– Documentation

Post – Follow up Problems IdentifiedOngoing Project . . .

• When family cannot be reached – not practical for resident/attending to continue searching for family after reasonable time period (48 hours)

• Physician entering autopsy order/obtaining autopsy consent is usually resident (not attending)– Important for when physician is covering (NF, PAC)– Important for disclosure

• Difficult to keep track of autopsy report when it takes 6-12 weeks to come back, and doesn’t always make it to resident