31 July 2012
Poor consent practices cause decline in hospital post-mortems
The failure by hospitals to obtain consent has led to a decline in the number of post-mortem examinations from 42% in 1979 to 15% in 2001. An analysis of 23 NHS Trusts published today in the Journal of the Royal Society of Medicine paints a picture of regulatory non-compliance, underdeveloped training and disparate practice that does not serve the needs of the bereaved or the medical profession.
Hospital post-mortem examinations can bring tangible benefits for bereaved relatives, many reporting a sense of ‘closure’ in knowing the cause of death and in a sense of the deceased helping others even in death. For the medical profession the hospital post-mortem has demonstrable benefits, for example in medical education for undergraduates and trainees and in auditing the rate of misdiagnosis and the accuracy of death certificates. In their paper the authors ask if it could be the case that clinicians themselves are responsible for the decline they lament.
Lead author Jaimie Henry, of Imperial College School of Medicine, said: “When we analysed the individual reports of NHS Trusts inspected by the Human Tissue Authority between 2010 and 2011 we found that 48% were failing to follow the Human Tissue Act or Codes of Practice requirements for obtaining consent.” Shortcomings included consent being recorded on forms that were out of date or did not follow the Codes of Practice, the lack of an appropriate standard operating procedure for staff, and consent being obtained incorrectly from a next of kin rather than spouse or partner or other qualifying relationship.
Henry added: “Halting the decline in hospital post-mortem examinations lies with the quality of the consent process. Despite the general spirit of compliance with the Human Tissue Authority Codes of Practices among the Trusts we analysed, there is very little emphasis on the importance of quality consent for post-mortem examinations.”
To achieve best practice Henry recommends that NHS Trusts rigorously review their protocols and introduce a team approach between clinicians and trained bereavement staff in core-consent teams, as suggested by the Human Tissue Authority. “With the right team in place Trusts can ensure that the legal requirements for consent are being met and at the same time the rapport between the bereaved and the treating clinician is not lost to the consent procedure.” Henry gives an example where the success rate for obtaining consent for post-mortem brain retention increased from 0% to 71.5% through the work of a core consent coordinator who had responsibility for managing the consent process.
Henry concludes: “It could be that clinicians themselves are killing off any chance of a renaissance for the autopsy with a reluctance to request them and a poor attitude to consent. By adopting an evidence-based team approach, clinicians can avoid the stigma they alone attribute to post-mortem examinations, achieve regulatory compliance and increase post-mortem examination consent rates.”
Notes to editors:
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