The Autopsy Process Quality Improvement and Systems Based Practice Melissa 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 Disclosure May 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 Identified Ongoing 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