Role of Autopsy

Question 0

Discuss why the hospital autopsy is used for institutional quality assurance.

Answer 0

The autopsy is still the gold standard for quality assurance for both medical care and diagnostic accuracy.

• -Can see things a lot better, run more tests, get the whole story
• -Used to check if diagnosis was accurate

Question 1

Name 3 reasons for the decline in national autopsy rates.

Answer 1

The reasons for the decline in autopsy rates include (but are not limited to):

• -Over-confidence in clinical diagnoses and fear of litigation by clinicians
• -Negative attitudes by pathologists and the lack of reimbursement
• -Increasing resistance by the public

Question 2

Define the family hierarchy whereby legal permission for an autopsy can be granted.

Answer 2

Legal permission for autopsy can be granted only by family members in a very strict hierarchy:

1. Spouse
2. Adult son or daughter (18 or older)
3. Either parent
4. Adult brother or sister (18 or older)
5. Legal guardian or power of attorney (ONLY if no existing mentally competent family member)

Question 3

List 6 circumstances of death that must be reported to the State Medical Examiner.

Answer 3

1. Deaths from violence or unlawful act
2. Death following an accident (car accident, therapeutic intervention, fractured hip), even if months or years later
3. Suspicious, unusual, unnatural death
4. Any death in prison
5. Any death unattended by physician
6. Sudden death in person of good health or child <3, or SIDS death

Question 4

Autopsy rates

Answer 4

~5% US

<3% worldwide

Question 5

Describe who pays for a hospital autopsy to be performed.

Answer 5

Patient families do not incur costs, and are not charged, for the autopsy procedure
System/hospital pays for autopsy, generally through residency programs (medicare)

Question 6

State the frequency of major discrepancies between antemortem and post-mortem diagnoses today and in the past.

Answer 6

Major discrepancies = definitely or possibly affect clinical outcome

• -The frequency of major discrepancies between antemortem and postmortem diagnoses is ~30%.
• -Major discrepancies are 10% more likely at community hospitals than in academic medical centers (but this is NOT much)
• -Neither clinicians nor pathologists can predict before autopsy which cases will reveal a major discrepancy.
• -Despite new technological advances and diagnostic sophistication, the discrepancy rate between antemortem and postmortem diagnoses has not significantly changed over time.

Question 7

Quality assessment? What might a comprehensive QA program on the Autopsy Service include?

Answer 7

• Determination of the clinical significance of autopsy findings (Are there discrepancies?)
• Assessment of clinical factors that might have contributed to death (Are there errors?)
• QC value of the autopsy in Pathology (Is the autopsy performed well?)

Question 8

Will autopsy increase the likelihood of a lawsuit?

Answer 8

No, it is the best DEFENSE against a lawsuit.