Implementation of modern tools in autopsy practice—the way towards contemporary postmortal diagnostics
Medical, legal, and socioeconomic issues have contributed to the decline of autopsy rates. Pathology-related factors, however, with changing clinical duties on the one hand and decreasing interest and lack of substantial technical developments in this field on the other, may have contributed to this condition as well. We present our experience of a restructuring project that culminated in the introduction of a modernized postmortal diagnostic (PMD) unit: Workflows of PMD procedures and space organization were restructured according to LEAN management principles method. Classical autopsy suites were transformed into postmortal operating rooms. A PMD pathologist staff was designated to perform postmortal operative diagnostics (i.e., using laparotomy and thoracotomy approaches) with the intention of gradually replacing classical autopsy procedures. Postmortal minimal invasive diagnostics (PMID) using laparoscopy and thoracoscopy were successfully implemented with the expertise of clinical colleagues. Reorganization of workflow reduced turn-around times for PMD reports from a median of 33 days to 15 days. Short-term analysis revealed that this combined effort leads to a slight increase in the number of adult postmortal examinations 1 year after the introduction of this project. A change of culture in postmortal diagnostics may contribute to a better reputation of postmortal examinations from the perspective of clinicians, the general public, and affected relatives of the deceased. It may also serve to demonstrate that the pathology community is keen not only to preserve but also to further develop this valuable tool for medical quality control and education.
KeywordsAutopsy Postmortal diagnostics Minimally invasive LEAN management
The authors greatly appreciate the enthusiastic contribution of the autopsy assistants Patrycja Imiela, Sascha Häusler, and René Vögtli and our residents (Viktor H. Koelzer, MD, Gregor Rieger, MD, Bastian Dislich, MD, Monique Niklaus, MD, Claudia Jaccard, MD, and Ronan Gabriel, MD) to this project. We also thank Mrs. Carolin Hammer for her tremendous support during the implementation of the LEAN measurements.
RL and AL conceived and designed the study, and wrote, edited, and reviewed the manuscript. AT and BS researched and analyzed data, and wrote, edited, and reviewed the manuscript. MT, AB, YB, DC, and AP analyzed data, and edited and reviewed the manuscript. All authors gave final approval for publication. RL takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.
Compliance with ethical standards
The project was approved by the Ethics Committee of the canton of Bern (KEK 236/15).
Conflict of interest
The authors declare that they have no conflict of interest.
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