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The Department of Pathology will perform an autopsy upon the death
of a patient at Brigham and Women’s Hospital in accordance with
the following procedures. There is no charge to the patient’s
family for this service. In most cases, the autopsy does not delay
funeral arrangements. Viewing of the body is unaffected and there
are no noticeable changes in the appearance of the body.
I. NOTIFICATION OF THE DEATH OF A PATIENT
Upon the death of a patient, the floor coordinator or the primary
physician should call the Admitting Office, x27450, with the following
information:
1. Name of patient
2. Time of death
3. Name of physician who pronounced the patient dead
4. Whether the family has been notified
5. Whether permission for a post-mortem examination has been obtained,
provided that this is not a Medical Examiner Case (see below).
II. MEDICAL EXAMINER CASES
A. Cases that must be reported to the Medical Examiner include, but
are not limited to, the following:
1. Death on arrival
2. Death within 24 hours of admission
3. Death during the course of, or suspected to be related to, an interventional
procedure or medication (including deaths on the operating table or
in the recovery room).
4. Death after trauma, overdose or industrial accident regardless
of ensuing time interval or whether the trauma/overdose/accident directly
caused the death.
5. Fetal deaths if related to maternal trauma/drug use.
B. If the case falls within the jurisdiction of the Medical Examiner,
the physician that pronounced the patient must contact the Medical
Examiner's Office at 617-267-6767. A decision is usually made within
20-30 minutes during working hours. The decision may be deferred until
morning if the patient dies at night. If the Medical Examiner accepts
the case, the House Officer must forward the following paperwork to
the Admitting Office: Report of Death, Medical Examiner "Pink
Slip," Clinical Abstract, and patient chart (see below for details
on paperwork). The disposition of the case will be decided by the
Medical Examiner. In some cases, the Medical Examiner will perform
an autopsy.
C. If the M.E. declines the case or if there is no legal issue to
be dealt with, autopsy permission must be obtained as detailed in
IV. Do not seek autopsy permission from the family until the M.E.
has declined the case.
D. Contact with the M.E., and the decision regarding disposition,
must be documented in the patient's chart.
III. AUTOPSY CRITERIA
The Brigham and Women's Hospital Medical Staff recognizes that autopsies
are a valuable source of information which may be used to evaluate
the accuracy of clinical diagnoses and the efficacy and safety of
therapeutic interventions, to provide correlative data for quality
assessment and improvement activities, and to enhance education and
training in medicine.
Therefore, the Medical Staff should attempt to secure autopsies in
all deaths which do not fall under the jurisdiction of the medical
examiner, and are especially encouraged to pursue an autopsy in the
following circumstances:
1. All deaths in which the cause of death or a major diagnosis is
uncertain or is not known premortem.
2. Deaths in which there has been an invasive procedure, surgical
or pharmacological intervention, or diagnostic test where the autopsy
may help explain unknown and/or unanticipated complications.
3. Cases in which an autopsy may help allay concerns of, and provide
reassurance to, the family and/or public regarding the death.
4. Deaths of patients who have participated in clinical trials approved
by the institutional review board.
5. All obstetric and perinatal deaths.
6. Deaths in which it is believed that an autopsy would disclose a
known or suspected genetic or other illness that may have a bearing
on family members of the deceased or recipients of transplant organs.
7. Deaths known or suspected to have resulted from environmental or
occupational hazards.
8. Deaths that are subject to, but waived by, forensic medical jurisdiction.
In addition to providing formal and detailed reports of autopsy results,
the Department of Pathology will notify interested members of the
medical staff, especially the attending physicians and involved house
staff, when an autopsy on one of their patients is to be performed,
and will present results of autopsies to such members, as requested.
IV. OBTAINING PERMISSION FOR AN AUTOPSY
A. Autopsy permission must be obtained from the next of kin, defined
legally in the following order:
1. Spouse
2. Adult children: all surviving adult children must consent, either
in collective assent, or via a spokesperson
3. Parents
4. Adult siblings: all surviving siblings must consent, either in
collective assent, or via a spokesperson
5. Guardian of decedent at time of death
6. Any other person authorized or under obligation to dispose of the
remains
If there is uncertainty as to next of kin, the family members arranging
for the funeral are the ones who give permission ("right of possession
of the body"). Where there is no family, a close friend who is
making the funeral arrangements can give permission. Admitting is
very experienced in this area and should be consulted early for help
(x27450).
B. Filling out the Autopsy Permit Form:
The Autopsy Permit Form must contain the following information:
1. Name and unit number of patient. (Addressograph is preferable.)
2. Restrictions: written clearly (e.g., no brain; examination limited
to abdominal organs, etc.). Unrestricted autopsies, including, but
not restricted to, chest, abdomen, brain, and eyes, are the most valuable,
especially correlating autopsy findings with clinical features, for
understanding basic pathophysiology, and for donations. Make sure
the family understands this. Nevertheless, a restricted autopsy is
preferable to none at all. Examples of restrictions include: "no
brain," "abdomen only," "heart only," or
"liver biopsy only," as appropriate to the case. If there
are no restrictions, please write "None" on the appropriate
line. If there are restrictions, they should be worded with the physician's
guidance; the pathology prosector must follow restrictions precisely,
and cannot interpret the intent of the restrictions.
3. Signature of next of kin and relationship(s), dated individually.
4. Signature of physician, name (printed clearly), date.
5. Telephone authorization: Telephone authorization can be obtained
if the family cannot come to the hospital to sign the permit. The
phone permission must be witnessed by another staff person. The reverse
side of the Autopsy Permit form should be completed, including the
signature of the witness. Please consult with Admitting for this procedure.
6. Special arrangements: If any special arrangements have been made,
particularly with respect to the time for delivery of the body and
death certificate, please note them.
C. Patients previously cared for at Brigham and Women's Hospital who
die elsewhere (i.e. home, another hospital, nursing home, etc.) may
have an autopsy performed by the Pathology Department at Brigham and
Women's Hospital. There will be no pathology charges for the autopsy
itself. However, because funds are not available to cover transportation
expenses, costs of transporting the body to and from the Brigham are
usually borne by the family. In some cases, individual departments
have paid transportation costs. As with in hospital deaths, all appropriate
paperwork must be completed and available including the autopsy permit
clinical abstract form, and the patient’s chart. Arrangements
should be coordinated through the admitting office.
V. ASSEMBLING THE PAPERWORK
A. All Deaths
The following material should be forwarded to Admitting by the floor
coordinator or physician for any deceased patient:
1. Death Certificate: Fill out parts 25a, b and c in black ink (signature;
date: spelled out (July 12, 1988); and hour of death). Admitting will
complete the remainder of the Certificate.
2. Report of Death: Fill out the top portion, and cause of death.
3. # If the Medical Examiner was called, forward the Medical Examiner
"Pink Slip," indicating the disposition of the case.
4. Autopsy Permit Form: Refused or obtained. If the latter, fill out
as detailed above.
B. If there is an autopsy, forward in addition:
1. Clinical Abstract Form, with the following information:
a. Clinical abstract, filled in succinctly with a problem list orientation.
b. Questions of particular interest: What particular features of the
case need special attention?
c. Notification of staff prior to performing the autopsy and for viewing
and follow-up information with pager and/or telephone extension numbers.
d. Hazard Status
i. Infectious Diseases: Note if the patient has or may have active
hepatitis, tuberculosis, AIDS, etc.
ii. Radioactive Agents
e. Special studies of interest, e.g. special cultures, serologies,
and toxicologic studies
2. Patient Chart IF THERE ARE ANY QUESTIONS, PLEASE CONSULT FREELY
WITH ADMITTING. THEY ARE VERY EXPERIENCED IN THESE MATTERS.
VI. THE AUTOPSY
A. The autopsy begins when Pathology has:
o Report of Death
o Autopsy Permit form, authorized by Admitting
o Clinical Abstract Form
o Patient Chart
o The patient
B. Pathology will make a reasonable attempt to notify all staff listed
on the Clinical Abstract Form one time prior to beginning the autopsy
so that they may observe the results during or immediately after the
autopsy.
C. Autopsies are started from 8:00 a.m. to 3:00 p.m. seven days a
week, and at other times at the discretion of the Pathology Chief
Resident.
D. If any house officer has questions about the performance or status
of an autopsy, call the pathology resident on call, or as backup,
page the chief resident at 11661. All adult autopsies, (except infectious
cases,) are formally presented Monday and Wednesday at 8:00 a.m. and
Friday at 9:15 a.m., in the autopsy room located on L2. Clinical staff
are encouraged to attend any of these conferences without prior arrangement.
If attendance at this conference is not possible, other arrangements
may be made with the pathology resident/staff to view post-mortem
findings. Preliminary autopsy reports will be available to staff on
the hospital computer, usually within 48 hours of the performance
of the post-mortem examination, and later provided by mail.
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