Contemporary Coronial Autopsy Practice in the NHS : An Audit

Chowdhury, Samin and McGrath, Steven (2019) Contemporary Coronial Autopsy Practice in the NHS : An Audit. The Journal of Pathology, 249 (s1). pp. 5-22. ISSN 0022-3417

Abstract

An audit has been undertaken to review the coronial autopsy practice of a single histopathology consultant against the standards laid down by the Royal College of Pathologists 2002, National Confidential Enquiry into Patient Outcome and Death 2006, and Coroners Statistics Annual 2017 to identify areas of variance against national benchmarks. Outcomes from coronial autopsies facilitate trust morbidity and mortality review processes. The standard of post mortem practice and the accuracy of causes of death are therefore important factors to consider. The audit was approved by HM Coroner and registered with the Trust’s audit department. Data were retrospectively collected from all post mortem examinations performed by a single consultant in 2017. The corresponding patient records were also consulted. The diagnostic value of histology and toxicology samples was explored. Discrepancies between suggested clinically and pathologically diagnosed causes of death were scrutinised. No attempt was made to reach objective judgements about the overall quality of the autopsy reports. 108 cases were audited of which 59% cases were community deaths and 41% of cases were hospital deaths. Compliance against most key standards was high, e.g. inclusion of supporting documentation, mandatory demographic details, external and internal examination. 52% of cases involved the retention of tissue samples; substantially higher than the national average for 2017 (23%). Histology confirmed the cause of death suspected during the post mortem examination (36%) or was essential in determining the cause of death (43%) in cases where tissue blocks were retained. Toxicology samples were retained in 24% of cases, compared to the national average (20%). It played a key role in determining the cause of death in 31% of cases. 60% of hospital deaths did not contain any clinical cause of death in medical notes. The clinician and pathologist given causes of death were similar in 33% of cases and significantly discrepant in 44% of cases. Histology remains a valuable component of autopsy practice. The autopsy sill has much to add when the cause of death cannot be determined clinically. Toxicology is very important in a small number of community deaths.