Robinson Claire, Deshpande Aparna, Richards Cathy, Rutty Guy, Mason Catherine, Morgan Bruno
Department of Imaging, University Hospitals of Leicester NHS Trust, Leicester, England.
Department of Histopathology, University Hospitals of Leicester NHS Trust, Leicester, England.
BJR Open. 2019 Jul 26;1(1):20190017. doi: 10.1259/bjro.20190017. eCollection 2019.
Post-mortem CT (PMCT) can replace autopsy in many cases of non-suspicious death. A purely NHS-based service to replace autopsy with PMCT was launched, with the cost met by the family from 2015 to 2017, and subsequently "free at the point of delivery" after local authority funding was secured. The aim of the service was to improve the experience for the families. This report describes and evaluates the service against local standards of (1) less than four day turn around, (2) cause of death given in >90% and (3) less than 10% require autopsy.
A retrospective review of reports, records and emails was undertaken to collate demographics, times of different stages of the process, the outcome and comments from service users.
Between July 2015 and July 2018, 279 patients had PMCT scans, 67 (24.0%) in the family-funded service and 212 (76%) in the current service. 97.1% ( = 271/279) of cases had the radiology report issued by day 3 (96.8% 98.6% for the family funded and local authority-funded services respectively). A cause of death was given in 97.2% of scans. 2.8% of patients required autopsy. Feedback from families, coroner's officers and undertakers has been overwhelmingly positive.
The services exceeded local standards and met the needs of the Coroner and the families based on the feedback received. This model could be employed for similar services, but the change to the logistics and financial structures required to initiate such services remains a significant hurdle.
This is the first report of a fully NHS-based PMCT service.
在许多非可疑死亡病例中，尸检后CT（PMCT）可替代尸体解剖。一项完全基于国民保健服务体系（NHS）的用PMCT替代尸体解剖的服务启动，2015年至2017年费用由家属承担，随后在获得地方当局资金后实现“交付时免费”。该服务的目的是改善家属的体验。本报告根据以下当地标准描述并评估该服务：（1）周转时间少于4天；（2）死因给出率>90%；（3）需要尸体解剖的比例少于10%。
对报告、记录和电子邮件进行回顾性审查，以整理人口统计学信息、过程不同阶段的时间、结果以及服务使用者的意见。
2015年7月至2018年7月期间，279例患者接受了PMCT扫描，其中67例（24.0%）在家庭资助服务中，212例（76%）在当前服务中。97.1%（=271/279）的病例在第3天出具了放射学报告（家庭资助服务和地方当局资助服务分别为96.8%和98.6%）。97.2%的扫描给出了死因。2.8%的患者需要尸体解剖。来自家属、验尸官官员和殡仪业者的反馈总体上是积极的。
根据收到的反馈，该服务超出了当地标准，满足了验尸官和家属的需求。这种模式可用于类似服务，但启动此类服务所需的物流和财务结构的改变仍然是一个重大障碍。
这是关于完全基于NHS的PMCT服务的首份报告。
