3/8/2018 MEDT230
20 percent of the 2.4 million deaths in the US each year are investigated. Vast majority of them are a natural manner of death. (In this country.) What is an Autopsy actually doing? Looking for the cause and manner of death. It is different in the hospital autopsy. Autopsy is considered the gold standard for DIAGNOSIS. Opportunity to recognize MISSED DIAGNOSIS.
If patients are treated incorrectly, and die there may be NO way to know and no way to improve practice. It's an opportunity to recognize errors and reduce errors in the future. There is a big decline in hospital autopsy.
DISCREPANCIES Class 1 (Huge medical mistake) : There is something you could have done. Knowledge of the diagnosis before death would have led to changes in management that could have prolonged survival or cure the patient. *** Review the rest of the classes on slide. But class one is the one you need to really know. If its a class 1 or class 2, they get flagged. Doctors get together and decide if its worth meeting w/ physician.
Using Criteria like those that the Goldman Published (thing above), rates of discordant autopsies have been reported to range anywhere from 17-48 percent. That means 25 percent show discordant findings. This doesn't mean that the findings are all major. In fact, they probably aren't.
AUTOPSY OVER TIME. -The rate of adult autopsy has declined over the latter half of the 20th century. WHY? One of the reasons: Were actually better figuring things out before people die. Were better at diagnosing things so we screw up less. We have more information coming at us in the front end Less of a chance we don't know what is going on. They feel like they don't need hospital autopsies. Reasons: Better medical understanding of many diseases, more advanced testing leads to better pre-mortem diagnosis, fewer in hospital pathologist doing autopsy, big hospital costs, Public perception (CSI Effect again?)
Why would someone in the hospital need an autopsy? -Natural death does not mean immediately explainable -Sudden death with no suspicious circumstances. -Patient w multiple medical probs. -Info for fam: Genetics, Cancer -Info for legal reasons: Asbestos. Who requests an autopsy?
Family, next of kin. -Physician.
Who does a hospital Autopsy? -Hospital Pathologists. -Freelance pathologist who comes to hospital -Outside pathologists
Autopsy TIMELINE. 1) Review the permit 2) Review chart 3) Gross exam 4) Internal exam 5) Pad 6) Microscopic exam 7) Final report
Autopsy Permit Review. Make sure the Autopsy is properly filled out. Next of Kin. Signature. Limit to post: (cut brain, dont cut brain. )
Chart Review -Freq. The most important part. -Think of the chart as the "scene" and "circumstances" -What testing did the patient already have? -What was the clinical suspicion? -What medications, surgeries, ect. -You may have to do some detective work, call physicians, ask for faxed reports, call family.
Who is doing the cutting? Diener An autopsy assistant. Handle move and clean corpse In some place