Communication of results of necropsies in north east Thames region.

Abstract

Objective-To evaluate the adequacy of reporting of results of necropsy to referring clinicians and to general practitioners. Design-Questionnaire survey of referring clinicians and general practitioners of deceased patients in four districts in North East Thames region. Patients were selected by retrospective systematic sampling of 50 or more necropsy reports in each district. Setting-One teaching hospital, one inner London district general hospital, and two outer London district general hospitals. Participants-70 consultants and 146 general practitioners who were asked about 214 necropsy reports; coroners' reports were excluded. Main outcome measures-Time taken for dispatch of final reports after necropsy, consultants' recognition of the reports, general practitioners' recognition of the reports or of their findings, and consultants' recall of having discussed the findings with relatives. Results-Only two hospitals dispatched final reports including histological findings (mean time to dispatch 144 days and 22 days respectively). 42 (60%) consultants and 83 (57%) general practitioners responded to the survey. The percentage of reports seen by consultants varied from 37% (n= 13) to 87% (n=36); in all, only 47% (39/83) of general practitioners had been informed of the findings by any method. Consultants could recall having discussed findings with only 42% (47/112) ofrelatives. Conclusions-Communication of results of necropsies to hospital clinicians, general practitioners, and relatives is currently inadequate in these hospitals. Implications and action-A report of the macroscopic findings should be dispatched immediately after necropsy to clinicians and general practitioners; relatives should routinely be invited to discuss the necroscopic findings. One department has already altered its practice.

Auditing necropsies.

“…A paper in this week's journal by Whitty and colleagues shows just how far below these standards some hospitals are falling (p 1244). 5 According to the joint working party, all necropsies should be accompanied by histological examination of the tissues, although this is sometimes not possible for coroners' cases, where histological examination may not be considered neces-sary to establish the cause of death. The counterargumentthat histological examination is always required to give a precise cause of death and to define other contributing diseases-has not yet been tested.…”

Is it possible and worth keeping track of deaths within general practice? Results of a 15 year observational study

“…Since the first published analysis of deaths in a UK general practice, 1 subsequent studies have examined several aspects of death registers in primary care. [2][3][4][5][6][7][8][9][10][11][12][13][14] Studies have focused on critical incident analysis, 8 bereavement protocols, 9 10 the legacy of deaths in general practice, 11 hospital communication to GPs, 12 communication of autopsy findings to GPs, 13 and use of practice level mortality data to inform health needs assessment. 14 Death registers have been found valuable in monitoring and improving quality of care, [2][3][4] and practice based audits of preventable deaths have been found educational and a source of ideas for service improvements.…”