Fu Lucy, Zak Taylor, Shanes Elisheva
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Acad Pathol. 2021 Apr 9;8:23742895211006821. doi: 10.1177/23742895211006821. eCollection 2021 Jan-Dec.
The COVID-19 pandemic created new challenges in health care, and pathology departments have led with innovations in testing and education. While the medical community and public showed great interest in gross and histologic findings in COVID-affected patients, paradoxically many autopsy services nationwide closed due to uncertainties surrounding the proximity to infected patient tissue, shortages in personal protective equipment, and pressures to discontinue perceived nonessential hospital operations. These disruptions furthermore negatively impacted pathology trainee education. The autopsy division at Northwestern Memorial Hospital, with the belief that a fully functioning autopsy service is especially crucial at this time, adopted a framework for continuing at full capacity for both clinical care and education. New operations were modeled on national protocols by the Centers for Disease Control and Prevention and the College of American Pathologists, and the service continually adjusted policies to reflect rapidly changing guidelines and feedback from trainees and staff. Between January and December 2020, we performed 182 adult autopsies including 45 COVID-19 autopsies. Twelve residents, 4 staff, and 5 attendings rotated through the service. In exit interviews, participants expressed: (1) improved comfort managing both COVID-related and general autopsies; (2) sense of personal safety on service (despite the increased risk of exposure); (3) belief that both COVID-related and general autopsies contributed to their personal education and to the medical community. There have been zero known autopsy-related COVID-19 infections to date. We hope that our innovative autopsy service restructuring can serve as a framework for other academic programs during the current and in future pandemics.
新冠疫情给医疗保健带来了新挑战，病理科在检测和教育方面引领创新。尽管医学界和公众对新冠感染患者的大体和组织学检查结果表现出极大兴趣，但矛盾的是，由于靠近感染患者组织存在不确定性、个人防护设备短缺以及停止被视为非必要医院业务的压力，全国许多尸检服务都关闭了。这些干扰还对病理学实习生的教育产生了负面影响。西北纪念医院的尸检部门认为，在这个时候全面运作的尸检服务尤为关键，因此采用了一个框架，以维持临床护理和教育的满负荷运转。新的操作模式借鉴了美国疾病控制与预防中心和美国病理学家学会的国家方案，该服务不断调整政策，以反映迅速变化的指南以及实习生和工作人员的反馈。在2020年1月至12月期间，我们进行了182例成人尸检，其中包括45例新冠尸检。12名住院医师、4名工作人员和5名主治医生轮流参与了这项服务。在离职面谈中，参与者表示：（1）在处理新冠相关和普通尸检方面的舒适度有所提高；（2）在服务过程中有个人安全感（尽管接触风险增加）；（3）认为新冠相关和普通尸检都有助于他们的个人教育以及医学界。迄今为止，已知与尸检相关的新冠感染病例为零。我们希望我们创新的尸检服务重组能够为当前及未来疫情期间的其他学术项目提供一个框架。
