Clayton S A, Sivak S L
Department of Medicine, Westchester County Medical Center, New York Medical College, Valhalla 10595.
Am J Med. 1992 Apr;92(4):423-8. doi: 10.1016/0002-9343(92)90273-e.
Although the autopsy is widely recognized as an invaluable tool for medical education, as well as the gold standard by which the accuracy of diagnoses are measured, there has been a steady decline in the autopsy rate over the last 20 years. At Westchester County Medical Center, a university hospital of New York Medical College, we observed an alarming drop in our autopsy rate. We realized that the methods used to obtain consent from the family of the deceased were haphazard and often left to the junior houseofficer available. We hypothesized that we could increase the autopsy rate by explicitly involving senior housestaff in the task of obtaining autopsy consent after giving them formal instruction in the technique of asking for consent and by having them record information regarding their encounters with families.
Data concerning the frequency of autopsies at Westchester County Medical Center were collected for a 3-month period in 1990. A corresponding period in 1991 was designated the study period during which our intervention was initiated. All medical examiner's cases were excluded for both periods since autopsy consent for these patients is not at the discretion of the family. At the start of the study period and each month thereafter, formal instruction regarding obtaining permission for autopsy was given to all senior residents assigned to direct patient care duty. The senior resident was required to complete a data form regarding autopsy request on each patient who died.
Nine autopsies among 89 deaths (10%) were obtained during the study period in 1990, compared with 31 autopsies among 116 deaths (27%) in 1991 (p less than 0.01). In 1991, autopsies were more likely to be obtained when death was unexpected (p less than 0.05).
The institution of a formal program to educate and involve the senior resident staff in obtaining autopsy consent can significantly improve the autopsy rate at a university hospital.
尽管尸检被广泛认为是医学教育的一项宝贵工具，也是衡量诊断准确性的金标准，但在过去20年里尸检率一直在稳步下降。在纽约医学院的大学附属医院韦斯特切斯特县医疗中心，我们发现本院的尸检率出现了惊人的下降。我们意识到，从死者家属那里获得同意的方法很随意，通常由在场的低年资住院医生负责。我们推测，通过让高年资住院医生在接受关于征求同意的技巧的正式培训后明确参与到获取尸检同意的任务中，并让他们记录与家属沟通的信息，我们可以提高尸检率。
收集了1990年韦斯特切斯特县医疗中心3个月期间尸检频率的数据。1991年的相应时间段被指定为研究期，在此期间我们开始了干预措施。两个时间段都排除了所有法医案件，因为这些患者的尸检同意不由家属决定。在研究期开始时及之后的每个月，对所有被分配直接负责患者护理工作的高年资住院医生进行关于获取尸检许可的正式培训。要求高年资住院医生为每一位死亡患者填写一份关于尸检请求的数据表格。
1990年研究期内89例死亡中有9例进行了尸检（10%），而1991年116例死亡中有31例进行了尸检（27%）（p<0.01）。1991年，意外死亡时更有可能进行尸检（p<0.05）。
建立一个正式的项目来教育并让高年资住院医生参与获取尸检同意，可以显著提高大学医院的尸检率。
