From chaos to order—and compassion—in autopsies

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Anne Ford

November 2014—Pathology resident Beth Ellen Frost, DO, has at times taken an uncommon step to put family members at ease when they are asked to consent, or have consented, to an autopsy for a loved one: She’s providing her cell phone number.

Simple but purposeful, and it’s one part of a new initiative to improve the University of Kentucky HealthCare system’s autopsy process, which has other pathology staff handing out numbers too.

Dr. Frost

Efforts underway include not only making pathology staff more available to the families of the deceased, but also making autopsy results more readily available in the electronic health record, revising the autopsy consent form, and helping clinicians answer the families’ questions when they seek that consent.

Why the move to bring more order? Because clinicians today are less familiar with autopsy procedures and requirements than were clinicians in past years. Television shows have given unrealistic impressions of what an autopsy entails. And few institutions have a dedicated decedent affairs office to handle end-of-life care.

“All of a sudden, these grieving relatives have thrust upon them decisions that have to be made fairly rapidly,” says Gregory J. Davis, MD, professor of pathology and laboratory medicine in the UK College of Medicine, co-director of UK HealthCare’s autopsy service, director of its Division of Forensic Consultation Service, and vice chair of the CAP Forensic Pathology Committee. “‘Should we get an autopsy? What is an autopsy? How do I give permission for an autopsy? Will it delay the funeral? Can we still show the body at the funeral home?’ If you don’t have a system in place, all of a sudden the chaos of activity around the death is just that—chaos.”

Dr. Dukes

Preventing chaos is what’s behind the autopsy efforts underway at UK HealthCare. Heading up the changes is a new autopsy committee co-chaired by Dr. Frost and another pathology resident, Grace Dukes, MD, a member of the CAP Forensic Pathology Committee. “Early in our residency,” Dr. Dukes says, “we thought improvements could be made to the autopsy service in terms of streamlining and helping clinicians with our diagnoses. So we set up a meeting with the director of the autopsy service and made our suggestions, and we were then asked to be co-chairs of an autopsy committee focused on improving the service.”

One of the committee’s most pressing tasks: Clarifying and streamlining the autopsy consent form. The existing document was so confusing that clinicians frequently filled it out incorrectly, says UK College of Medicine professor and UK HealthCare autopsy service director William O’Connor, MD. This meant that the laboratory then had to chase the clinicians down, have them contact the family again, and get a new form completed. “Up to 75 percent of the time, the permission needed to be revised,” he says.