Analysis ofnecropsyrequestbehaviour ofclinicians

Aim-Todevelop anecropsy related audit systemtorecordaccurate information in relation tonecropsyrequests, necropsy ratesandcoronial referrals. Methods-Asimpleauditformwasused torecorddetailed necropsy related data viaanintegrated questionnaire design and dataentrysystembasedonavailable optical imagescanning technology. Thesystemrecorded thenumbersandlocations ofdeaths, referrals tothecoroner, clinical necropsyrequests, hospital and medicolegal necropsies, thegradeofclinician involved intheseprocesses, andtheidentity oftheconsultant incharge ofthecase. Theoverall, hospital andmedicolegal necropsyrateswerecalculated byindividual consultant, specialty andforthewhole hospital. Necropsy request ratesandcoronial referral rateswerealsocalculated andthesedatawererelated tothegrade ofclinician. Alldatawereavailable ona monthly oranaccumulative basis. Results-Of 1398deaths, 534(38%)were discussed withthelocalcoroner's office and167ofthese wereaccepted forfurther investigation. Houseofficers andsenior houseofficers referred over80% ofall cases, whereasconsultants referred only 2%.Therewerenosignificant differences incaseacceptance ratesbygradeofclinician.Clinicians made 307hospital necropsyrequests (overall hospital necropsy request rate22%).Houseofficers made 65%ofallnecropsy requests. Consultant necropsy requests represented 13%ofall requests. There were no significant differences innecropsyrequestsuccess ratesbygradeofclinician. Conclusions-The referral ofcasestocoronersandclinical necropsy requests are still beinginappropriately delegated tothe most juniorclinicians. Thisstudyillustrates thetypeofuseful information whichcanbeproduced forindividual clinicians, specialty auditgroupsandpathologydepartments usingasimple necropsy related auditsystem. (JClinPathol 1996;49:29-33)