Autopsy Service Manual - Pathology

1 Autopsy Service Manual Department of Pathology Yale University School of Medicine Yale-New Haven Hospital Bridgeport Hospital VA-Connecticut - West Haven 2014 Contents Page ii Yale Autopsy Service Manual Rev. 6/14 KMR Autopsy Service Manual Department of Pathology Yale University School of Medicine Yale-New Haven Hospital Bridgeport Hospital VA Connecticut West Haven June, 2014 Initially written and compiled by: John H. Sinard, MD, PhD Edited by: Kisha Mitchell Richards MD Contents Page ii Yale Autopsy Service Manual Rev.

2 6/14 KMR Table of Contents General Introduction .. 1 Mission of the Autopsy Service .. 2 Resident Competencies (Updated 2014) .. 2 Resident Supervision while on the Autopsy Service .. 6 Organization and Personnel (Updated 2014) .. 7 The Yale Autopsy Process .. 9 Brief Overview of the Autopsy Process (Updated 2014) .. 10 Detailed Overview of the Autopsy Process (Updated 2014) .. 11 Neuropathology Experience on Autopsy (Updated 2014) .. 19 Additional Rules for Special Situations (Updated 2014) .. 20 Weekend Cases .. 20 Brain Only Cases.

3 21 Bridgeport Hospital Cases .. 23 VA Connecticut West Haven Cases .. 23 Retention and Storage of Organs/Tissues (Updated 2014) .. 24 Time Course for the Autopsy .. 26 Summary of Individual Responsibilities (Updated 2014) .. 27 Junior Resident Responsibilities .. 27 Senior Resident Responsibilities .. 28 Attending Pathologist Responsibilities .. 30 Autopsy Manager Responsibilities .. 31 Autopsy Technician Responsibilities .. 31 Transcription Unit Responsibilities .. 32 Housestaff Credit for Autopsy Cases .. 33 Gross Pathologist(s) / Prosector(s).

4 33 Attending / Primary Pathologist(s) .. 34 Procedure Pathologist(s) .. 34 Brain Only Autopsy Cases .. 35 Fetal Autopsy Cases .. 35 Technical Procedures .. 37 Universal Precautions .. 38 Cleanliness in the Autopsy Suite .. 39 Sharps Biosafety .. 39 Frozen Section Biosafety .. 39 Special Handling of Known Infectious Cases .. 39 Special Considerations for Tuberculosis Cases .. 40 Contents Page ii Yale Autopsy Service Manual Rev. 6/14 KMR Special Considerations for Suspected Creutzfeldt-Jakob Cases .. 40 Radiation Safety .. 41 Accidental Exposure.

5 41 The Autopsy Dissection - Adult (Updated 2014) .. 41 External Examination .. 42 Opening the Body .. 42 The in situ Examination .. 42 Organ Removal: The En Bloc Technique .. 43 Organ Removal: The En Masse Technique .. 44 Completing the Evisceration .. 44 Removal of the Brain and Eyes .. 44 Dissection of the Individual Organs and Organ Blocks .. 45 The Autopsy Dissection - Pediatric (<18 years) .. 48 External Examination and Description .. 48 Initial Incision .. 49 Examination of the Abdominal Contents in situ .. 49 Description of the Thoracic Contents in situ.

6 50 Ligation of Vessels and Removal of the Block .. 50 Dissection and Description of Organs/Systems .. 50 Recommendations for Special Situations .. 53 Gross Photography .. 55 Freezing Potentially Diagnostic Tissue .. 56 Bulk Freezing of Tissue .. 56 Freezing of Tissue in .. 57 Tissue Procurement for Research .. 57 Other Special Techniques .. 58 Frozen Sections .. 58 Radio-opaque Dyes .. 58 X-rays .. 58 Tetrazolium Red .. 58 Bacterial Cultures .. 59 Viral Cultures .. 59 Electron Microscopy .. 60 Immunofluorescence .. 60 Brain Perfusion.

7 60 Asbestos Fibers .. 60 Others .. 61 Molecular Diagnostics Experience .. 61 The Autopsy Report .. 63 The Provisional Anatomic Diagnosis (PAD) .. 64 Additional General Rules-of-thumb for the PAD .. 66 The CAUSE OF DEATH Statement: .. 66 Examples of PADs (Updated 2014) .. 68 The Final Anatomic Diagnosis (FAD) .. 71 Guidelines for the FAD (in addition to those for the PAD) .. 71 The Clinical-Pathological Summary (CPS) .. 71 Contents Page iii Yale Autopsy Service Manual Rev. 6/14 KMR Objectives .. 71 Guidelines for Content and Format of the CPS.

8 72 Sample Clinical-Pathological Summaries .. 73 Autopsy Findings .. 79 Hints and Recommendations: .. 79 Gross Autopsy Findings - ADULT .. 81 Gross Autopsy Findings PEDIATRIC/PERINATAL .. 86 SAMPLE Autopsy Findings (ADULT) .. 89 Neuropathology Evaluation .. 91 Clinical-Pathological Clarifications/Discrepancies .. 92 Education on the Autopsy Service .. 95 Conferences (Updated 2014) .. 96 Daily Case Review Conferences .. 96 Neuropathology Brain Cutting Conference .. 97 Autopsy Case Presentation Conference .. 97 Autopsy / Forensic Pathology Journal Club (New 2014).

9 98 Additional Clinical Conferences .. 98 Medical Student Teaching .. 98 Teaching Collection .. 98 OtherAdministrative Matters ..101 The Autopsy Permission .. 102 Medical Examiner Cases .. 103 Use of Autopsy Material for Research .. 103 Quality Assurance .. 103 Intradepartmental .. 103 Interdepartmental .. 104 General Introduction General Introduction Page 2 Yale Autopsy Service Manual Rev. 6/14 KMR The Yale Pathology Autopsy Service investigates disease by postmortem study of tissues and clinical records. This investigation is crucial to the continuing education of the hospital s medical staff, for obtaining important epidemiological information, as a quality control mechanism for the hospital, and to provide teaching material for pre- and post-graduate training.

10 The Yale Medical School department of Pathology provides Autopsy services for Yale-New Haven Hospital, Bridgeport Hospital, and the West Haven branch of the VA Connecticut Healthcare System. In addition, the New Haven-based staff also provides morgue services for Yale-New Haven Hospital. The Autopsy is the ultimate outcomes measure device for use in the hospital s quality control and quality assurance programs. The Autopsy is not merely the evisceration and dissection of the organs; it begins with the review of the medical record and continues through the writing of the clinical-pathological correlation and the presentation of the case at clinical conferences.