Postmortem guidelines are frequently not followed

June 30, 2003

Guidelines for completing death certificates and seeking consent for a necropsy are frequently not followed, and many of these activities are being undertaken by junior medical staff, concludes a study in Journal of Clinical Pathology.

Data over a one-year period were collected for all deaths at the Royal Hallamshire Hospital in Sheffield to determine the frequencies with which death certificates were completed and necropsies were requested. The seniority of the doctor undertaking these duties, and the type and planned uses of the tissues retained, were recorded.

Doctors completed proformas for 966 deaths and a death certificate was issued in 855 cases. Most death certificates (89%) were issued by preregistration and senior house officers.

The overall necropsy rate was 13%. Consent was sought in 6% of cases (usually by non-consultant staff) and was granted in 43.4% of these. Tissues were retained from 55% of necropsies for diagnostic purposes.

Death certification and seeking consent for a necropsy are frequently delegated to junior medical staff, despite two reports recommending that death certification should be the duty of a senior member of the clinical team, say the authors. This may explain the low standard of death certification reported in other studies.

Furthermore, necropsy rates have continued to decline since 1993, although it is too early to tell whether the recent "organ retention scandal" has had a negative impact on the postmortem rate. If the poor quality of death certification and the declining necropsy rate are to be reversed, these issues need to be dealt with, they conclude.


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