1.3c - Anatomic Pathology - Morgue/Autopsy Protocol

ANATOMIC PATHOLOGY -MORGUE/AUTOPSY PROTOCOL
When a deceased patient is transported to the West Roxbury Division, or permission is granted at the West Roxbury division, for an autopsy the following steps should be followed:

1. The contracted hearse driver/service nurse/provider should report to MAS's decedent affairs clerk/AOD; and deliver the patient's chart.
2. The decedent affairs clerk/AOD should review the AUTHORIZATION FOR AUTOPSY for completeness, correctness and legal aspects. If there is a problem with any of the aforementioned items the decedent affairs clerk/AOD should contact the originating VA Division (from which the patient came) and work with their MAS service to correct the problem. Upon proper completion of this authorization MAS should deliver the chart to the Pathology and Laboratory Medicine Service (PALMS).
3. MAS's decedent affairs clerk/AOD will notify the pathology department and other related services of the pending autopsy via the appropriate e-mail group.
4. The PALMS will accession the autopsy into the BHS (West Roxbury division) system. An accession number (RAU) will be generated for the autopsy.
5. The autopsy is performed by the Anatomic Pathology staff.
6. Upon completion of the autopsy procedure the responsible staff pathologist will reply to the initial e-mail with the preliminary cause of death and duration of pathology. Upon receipt of this e-mail response, the death certificate will be completed by the MAS's decedent affairs clerk/AOD and the remains will be released to the appropriate funeral home.
7. The completed autopsy report is typed.
   1. For Boston Healthcare System (JP/WX/BR) cases the complete report is entered into the BHS system.
   2. For Referral cases ONLY: Under the CLINICAL DIAGNOSIS area of the report the originating VA Division's accession number and name will be included; e.g. "CLINICAL DIAGNOSIS (A98-1) BEDFORD VAMC".
   3. For Referral cases: The West Roxbury VA accession number will be used in the PROVISIONAL ANATOMIC DIAGNOSIS area; e.g. "PROVISIONAL/FINAL ANATOMIC DIAGNOSIS (A98-12) WEST ROXBURY VAMC" in the remote system i.e. BEDFORD.
8. For BHS cases the final report is electronically signed by the pathologist and stored as a TIU document in the patient’s CPRS/GUI record under the Anatomic Pathology Reports Tab.
9. For Referrals ONLY: After the completed autopsy report is typed into the Referral system (i.e. Bedford) it is electronically signed by the pathologist and stored as a TIU document in the patient’s CPRS/GUI record under the Anatomic Pathology Reports Tab.
10. Brain specific process:

• Specimen:
• Fix in 10% NBF for two weeks
• Drain formalin from container
• Wrap in formalin moist paper towel pack
• Place in plastic bag
• Proper shipping container (Styrofoam box in a cardboard shipping box)
• Ship by courier.
• PROCEDURE:
• The specimen container is labeled with two full patient identifiers (full name and social security number)
  The accompanying autopsy report contains the following:
• Full name and social security number
• Location of removal
• Date obtained
• Provider/Pathologist name and phone number
• Results

• Cases will be processed upon receipt. Neuropathology reports will be added to the sending site autopsy reports as supplemental reports and released by the sending site pathologists.

Note: Autopsy procedures will NOT be performed on patients with the clinical history of, or suspicion of, Creutzfeldt-Jakob Disease (CJD). (Refer to Creutzfeldt-Jakob Disease Autopsy Protocol)

ANATOMIC PATHOLOGY –
Creutzfeldt-Jakob Disease Autopsy Protocol
As the Pathology and Laboratory Medicine service does not have the autopsy facilities to safely conduct an autopsy on a known or suspected case of CJD, autopsies will not be performed on patients with a confirmed or suspected diagnosis of CJD. If the next of kin so desires arrangements for autopsy will be made by the National Prion Disease Pathology surveillance Center (NPDPSC) in Cleveland, Ohio to perform the brain autopsy at an outside facility accustomed to handling such cases (i.e. MGH). Upon receipt by the BACL Pathology and Laboratory Medicine Service of a “negative for CJD” report from the National Prion Center, a full body autopsy procedure can be performed at West Roxbury VAMC with next of kin permission.
Note: The BACL Pathology and Laboratory Medicine Service will not perform any autopsy procedures on deceased patients with suspected CJD until CJD is ruled out by the National Prion Disease Pathology Surveillance Center in Cleveland, Ohio. The following are the steps necessary a brain only autopsy with the NPDPSC:

1. The deceased patient’s family must fill out and sign the NPDPSC’s Brain Only Autopsy Consent form.
2. The deceased patient’s family or physician contacts the autopsy coordinator at the NPDPSC to make arrangements for the autopsy. The autopsy coordinator’s phone number is 216-368-0587.  After speaking the autopsy coordinator the autopsy consent form should be faxed to NPDPSC, the fax number is 216-368-4090.
3. Once the family has notified the NPDPSC of their desire for an autopsy the NPDPSC will make the necessary arrangements at an outside facility for the autopsy free of charge.
4. The final diagnosis should be available from the NPDPSC 1½-2 months. To learn the status the case the autopsy coordinator is available to discuss the status of the case.
5. It is the policy of the NPDPSC to only release autopsy results to the deceased patient’s physician or any other qualified physician. The Laboratory Service requires a copy of the autopsy results.

Autopsy