ANALYSIS OF NECROPSY REQUEST BEHAVIOR OF CLINICIAN

Aim-To develop a necropsy related audit system to record accurate info rmation in relation to necropsy requests, necropsy rates and coronial referrals. Methods-A simple audit form was used to record detailed nec ropsy related data via an integrated questionnaire design and data ent ry system based on available optical image scanning technology. The sy stem recorded the numbers and locations of deaths, referrals to the co roner, clinical necropsy requests, hospital and medicolegal necropsies , the grade of clinician involved in these processes, and the identity of the consultant in charge of the case. The overall, hospital and me dicolegal necropsy rates were calculated by individual consultant, spe cialty and for the whole hospital. Necropsy request rates and coronial referral rates were also calculated and these data were related to th e grade of clinician. All data were available on a monthly or an accum ulative basis. Results-Of 1398 deaths, 534 (38%) were discussed with t he local coroner's office and 167 of these were accepted for further i nvestigation. House officers and senior house officers referred over 8 0% of all cases, whereas consultants referred only 2%. There were no s ignificant differences in case acceptance rates by grade of clinician. Clinicians made 307 hospital necropsy requests (overall hospital necr opsy request rate 22%). House officers made 65% of all necropsy reques ts. Consultant necropsy requests represented 13% of all requests. Ther e were no significant differences in necropsy request success rates by grade of clinician. Conclusions-The referral of cases to coroners and clinical necropsy requests are still being inappropriately delegated to the most junior clinicians. This study illustrates the type of usef ul information which can be produced for individual clinicians, specia lty audit groups and pathology departments using a simple necropsy rel ated audit system.