ENHANCING AUTOPSY PERFORMANCE AND REPORTING - A SYSTEM FOR A 5-DAY COMPLETION-TIME

Objective.-To develop a system for enhancing the performance and repor ting of autopsies in an effective and clinically useful manner. Design .-Twelve steps were defined as essential for the completion of the aut opsy. Each step of the process was evaluated for usefulness and effect iveness. Setting.-Autopsies performed in a university hospital from 19 92 through 1994. Participants.-Pathology residents and staff, clinicia ns, and clinical team house staff. Intervention.-Participants followed the 12-step process, with emphasis on involving the clinical team in the interview, prosection, and final rounds. The final rounds conferen ce was designated a working conference, where the perfused-fixed brain was cut, histologic sections of the case were submitted, and the prov isional diagnosis was written with the clinicians. A next-day microsco pic slide review session was scheduled to ''sign out'' the case. Estab lishing a philosophy of status equal to all other department functions facilitated implementation. Main Outcome Measure.-All autopsies perfo rmed for a period of 3 years (2 retrospective and 1 prospective) were included. Results.-The completion time for the autopsy was reduced fro m a mean of 57 days (range 7 to 174) in 1992 to 4.8 days (range 1 to 1 6) in 1994. Conclusion.-The autopsy completion time was reduced, incre asing its usefulness for teaching and quality assurance. Relationships with the clinical staff were enhanced with consultation-style final r eports. Enthusiasm for, and satisfaction with, the new process was exp ressed by clinicians, pathology staff, residents, and technical suppor t staff.