Zarbo R J, Baker P B, Howanitz P J
Department of Pathology, Henry Ford Hospital, Detroit, MI 48202, USA.
Arch Pathol Lab Med. 1996 Apr;120(4):346-52.
To develop a multi-institutional reference database of autopsy practices and performance for quality improvement purposes.
In 1992, participants in the Q-Probes quality improvement program of the College of American Pathologists each prospectively evaluated consecutive autopsies performed over a 6-month period, up to a maximum of 20 autopsies per institution.
Hospital-based autopsies, excluding forensic cases and stillborn infants.
Four hundred forty-nine North American institutions and three Australian laboratories.
Completeness of information contained on autopsy permit forms, timeliness of autopsy performance between patients' deaths and autopsy prosections, and turnaround time of preliminary autopsy reports.
In the aggregate database of 5434 autopsy cases, 7 of 11 selected data items were consistently present on autopsy permit forms in 80% of the participating institutions. The median percentage of autopsies in which permission was given for an unrestricted (complete) autopsy was 71%. The following median time intervals were obtained: time of the patient's death to time the autopsy permission was received, 5 hours, 23 minutes; time the autopsy permission was received to time the prosection was started, 3 hours, 30 minutes; and time of the patient's death to time the prosection was started, 14 hours, 52 minutes. Differences were observed in some time intervals when the participating institutions were grouped by reported demographic characteristics. Preliminary reports were completed in 2 days or less in 80.9% of the autopsies.
Through this multi-institutional study, we have documented a consistent core of autopsy permit form information requested and a wide range of time intervals elapsed between the patients' deaths and autopsy performance. We have also established that the majority of participating institutions meet the College of American Pathologists' laboratory accreditation standard of providing a documented preliminary report of the gross pathologic diagnoses submitted to the attending physicians and institutional record within 2 working days following autopsy completion.
建立一个多机构尸检操作与表现的参考数据库，以用于质量改进。
1992年，美国病理学家学会Q-Probes质量改进项目的参与者对各自机构在6个月内连续进行的尸检进行前瞻性评估，每个机构最多评估20例尸检。
基于医院的尸检，不包括法医案例和死产婴儿。
449家北美机构和3家澳大利亚实验室。
尸检许可表格中所含信息的完整性、患者死亡至尸检解剖之间尸检执行的及时性以及初步尸检报告的周转时间。
在包含5434例尸检案例的汇总数据库中，11个选定数据项中的7项在80%的参与机构的尸检许可表格中始终存在。给予无限制（完整）尸检许可的尸检中位数百分比为71%。获得了以下中位数时间间隔：患者死亡至收到尸检许可的时间为5小时23分钟；收到尸检许可至开始解剖的时间为3小时30分钟；患者死亡至开始解剖的时间为14小时52分钟。当按报告的人口统计学特征对参与机构进行分组时，在一些时间间隔上观察到了差异。80.9%的尸检初步报告在2天或更短时间内完成。
通过这项多机构研究，我们记录了所要求的尸检许可表格信息的一致核心内容，以及患者死亡与尸检执行之间经过的广泛时间间隔。我们还确定，大多数参与机构符合美国病理学家学会的实验室认可标准，即在尸检完成后2个工作日内向主治医生和机构记录提供 gross 病理诊断的书面初步报告。
