In order to promote medical audit and in the interests of undergraduate and postgraduate education, the policy of the Lothian University Hospitals Division is to request autopsy on as high a proportion deaths in hospital as possible.
Supplies of Request Forms and permission booklets may be obtained from the Mortuary Office (tel: 27177) or can be found on the Intranet here. (Internal users only)
Consent and Authorisation
- Formal written authorisation for an autopsy examination must be obtained on the current form from the deceased's nearest relative or nominated representative, as defined in the accompanying Information leaflet.
- Medical staff of at least FY2 level must obtain authorisation.
- All sections of the form must be completed for the form to be accepted.
- It is the duty of the individual obtaining consent to ensure that the family are aware of what they are consenting to and the limitations that restrictions imposed may have on the questions to be answered. It should be noted that the individual signing as the witness must not be the individual explaining the procedure.
- For advice contact the mortuary (RIE 27177).
- A Medical Certificate of Cause of Death (MCCD) must be issued before an autopsy will be performed. If an MCCD cannot be given the case must be referred to the Procurator Fiscal.
- The Procurator Fiscal should be contacted if there is any possibility that the death falls into the categories laid down by the authorities or there is any doubt about whether it may do so. Advice can be obtained from the mortuary ex 27177. Failure to observe this rule may delay the autopsy considerably. When the Procurator Fiscal maintains an interest in a case, the MCCD must not be issued without his permission.
Appendix V lists the circumstances when the Procurator Fiscal must be informed. 'Maternal deaths' only require to be reported to the Procurator Fiscal if they fall within one of the listed categories.
- The Edinburgh Procurator Fiscal can be contacted at the Death's Unit. Tel: 247 2831. The Police will take messages on behalf of the Procurator Fiscal over weekends and public holidays - Tel. 311 3131 and ask for the "Operations Room".
- When a case of a death due to medical mishap is reported to the Procurator Fiscal, Form F89 must be completed and dispatched to the Procurator Fiscal within twenty-four hours – refer to Appendix VII.
- Requests for a copy of reports from autopsies instructed by the Procurator Fiscal should be made to the Death's Unit of the Regional Procurator Fiscal at 29 Chambers Street, Edinburgh, EH1 1LD or by telephone (0131 247 2831).
Requests for Autopsy
- An autopsy request form must be completed for every autopsy.
- When a case has been discussed with the Procurator Fiscal, it must be clearly stated on the request form that permission to proceed with a hospital autopsy has been granted and appropriate authorisation has been obtained.
- When the extent of the autopsy examination has been limited by the relatives, this must be clearly marked on the request form.
- If any case carries a ‘Risk of Infection’ this must be clearly identified.
- The autopsy request form with authorisation form and case notes must be available for every case.
- Please ensure that the all the paperwork is made available to the mortuary as soon as possible after authorisation has been obtained.
- Out with normal working hours you can email the mortuary on LHBMortuary/Autopsy.PathologyService@nhslothian.scot.nhs.uk to advise that paperwork is available for collection.
- For autopsies at Borders General Hospital, please contact the PM Room (Tel: BGH 1503) as soon as possible to arrange the autopsy (see BGH Laboratory Handbook).
Discussion of Autopsy Findings
All clinical staff are encouraged to attend the autopsy discussion session. No autopsy can be regarded as complete unless it includes such a discussion between clinicians and pathologists. The clinician identified on the request form will be contacted when the autopsy has been completed and the case is ready for discussion.
A provisional summary of the main pathological findings is sent to the Ward immediately after the autopsy discussion. The final report, including histological findings, will normally follow within one month (90% of final reports will be issued within 21 days). However, specialist examinations, such as examination of the brain by the
Neuropathologists, may delay the final report.
A copy of the final autopsy report is sent to the patient's General Practitioner.
High Risk Autopsies
The Autopsy Suite in the RIE includes a facility for the examination of high risk of infection autopsies (Appendix I). ‘Risk of Infection’ should be clearly written in red on the autopsy request form and full details of the known / suspected infection should be specified.