*Paying Our Last Respects: The Neonatal Autopsy as Continuing Care and Ethical Obligation Jane Donohue Battaglia, MD, MA* +Author Affiliations* Associate Clinical Professor, A nesthesiology, Pediat rics and Preventive Medicine, Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, COOBJECTIVESAfter completing this article, readers should be able to:List the benefits of a postmortem examination.List possible reasons for the decline in autopsy rates.DECREASING RATES OF AUTOPSYEthical discussions of autopsies usually center around consent: how it must be requested, who may give it, or limitations on the procedure. All of these issues should concern us, but the real ethical issue about autopsies is that the procedure itself is not being done. The worldwide trend of falling autopsy rates (1) involves the United States; hospital rates of 60% in the 1950s fell to 12% in the early 1990s and less than 5% in nonteaching hospitals. (2) The average United States hospital rate of autopsies was 50% in the 1940s and 38% in 1973. (3) A review in 1983 at an adult teaching hospital documented a 75% rate in 1960, 71% rate in 1970, and 38% rate in 1980. (4) Although neonatal autopsy rates have maintained a higher level than those of adults, (5) they too are falling. In Scotland, rates began to decline in 1994. (6) In Wales, some rates fell below 50%, with neonatal perioperative autopsy rates at 45%. (7) The rate in one Australian center was 43% (8) and 39.7% in another. (9) In the United States, one study documented a decline in neonatal autopsies from a range of 63% to 81% down to 52% (10), and a 10-year series from 1984 through 1993 demonstrated a decrease from 71.2% to 47.7%. (11) http://www.npr.org/2012/02/05/146355717/fewer-auto psies-mean-crucial-info-goes-to-the-grave
Regina Holliday Ignite - Health Foo 5/12/12
The Patient Storyis sometimesdark and sometimes light.But both are needed for a masterpiece.These paints are same colorThey are defined by their tone.They provide a scale of Value.
This is another scale of value.“During this hospital stay, how often was your pain well controlled?”
Measurement cannot exist unless access is open and transparent, and this transparencymust continue unto the end. In order to provide necessary data for evidence based medicinewe must reinstate a statistically significant autopsy rate.In the United States; hospital autopsy rates of 60% in the 1950s fell to 12% in the early1990s and less than 5% in nonteaching hospitals.*Private autopsy services begin at $2,000.00 and are far out of reach of many consumers.In addition, studies find that there is disagreement between pre and post-mortem diagnoses in almost 30% of cases. “Truth is truth to the end of reckoning.”
Patient stories are more than core measures,surveys and bar charts.
Street Art:The more stickers that are out there the more important it seems.The more important it seems, the more people want to know what it is.The more they ask they ask each other.It gains real power from perceived power. -Shepard Fairey
We can redefine expectations of the role of art in medicineat every hospital, clinic and conference.
Sometimes we need to build bridges for better communication.
When we invite Moms and Dads, brothers and sisters to the table,we will have better outcomes emotionally and physically.