Posted June 1, 2007
Ashley O’Bannon, MD
CAP Autopsy Committee
The death of a patient is undoubtedly one of the most difficult situations you, as a clinician, will ever experience in your professional career. You will be expected to handle the complicated and sometimes unpredictable reaction of the bereaved family while simultaneously coping with your own personal emotions. You will also be responsible for providing information, comfort and support to these family members as well as to other clinicians and health care staff. In addition, there are the practical and logistical matters to coordinate: Who should be called? What documentation needs to be completed? How do you transport the body?
The management of a patient’s death can be challenging. Confusion is often confounded by the wide variation that exists between city, county and state regulations and individual hospital policies regarding postmortem care.
Recently, the College of American Pathologists (CAP) Autopsy Committee developed a postmortem care flow chart (PDF, 15 K) to help clinicians, other health care providers and funeral home directors streamline this process. This flow chart addresses the postmortem care issues in a logical and chronological sequence to ensure proper continuity of care and treatment of the body. Correct positioning, transportation, communication and documentation are important details in this process. This chart serves as an organizational model and, if needed, can be adapted to better accommodate your facility’s specific regulations. It is designed for use in any adult hospital death and is especially helpful for patients undergoing an autopsy. It illustrates points that are important to the autopsy pathologist and specifically addresses differences between forensic and hospital autopsy requirements.
Excluded from this chart are cases of infant and early fetal death. Often, fetuses under 500 grams or 20 weeks gestational age are not examined via a routine autopsy. In many institutions, early fetal deaths are given a more limited surgical pathology examination and are not considered autopsy cases. At this stage of development, cytogenetic studies may have a greater diagnostic yield than the gross or histologic evaluation. Frequently, differences exist among states with regard to the manner in which the fetal remains are disposed and the type of consent required.
Requesting consent for an autopsy should not be an added source of grief for either the family or the clinician. The CAP has an educational brochure “Autopsy: Aiding the Living by Understanding Death” and an autopsy request script that has proven useful to health care workers when discussing the option of an autopsy with the family. Do not assume that if the family wants an autopsy, they will ask you for one. This question is generally not foremost in their minds at this time. Therefore, if you do not offer them this option, you are essentially deciding for them that they don’t want one. The decision should be theirs.
Keep in mind that the autopsy can give peace of mind and closure to surviving family members by helping to answer questions about the death and relieve anxiety about what might have happened. Offering the autopsy to the family is a medical service. Even when the autopsy does not reveal unexpected findings or diagnoses, family members derive great comfort from knowing that the patient was correctly diagnosed and treated. In some instances, the autopsy can provide information on genetic and familial diseases, which can assist surviving relatives through counseling, lifestyle alterations, clinical follow-up and treatment. Information gained from the autopsy not only benefits the family, but the community as a whole. The vast knowledge gained is used to train physicians of all disciplines and is an important outcome measure by which to assess incidence and prevalence of disease, epidemiology, efficacy and/or side effects of medical treatments and the quality of patient care.
Postmortum Flow Chart (PDF, 15 K)
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NewsPath® Editor: Megan
J. DiFurio, MD, FCAP
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