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The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia
Author(s) -
Davies David J,
Graves Debra J,
Landgren Anthony J,
Lawrence Chris H,
Lipsett Jill,
MacGregor Duncan P,
Sage Martin D
Publication year - 2004
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2004.tb05926.x
Subject(s) - autopsy , medicine , health care , cause of death , modalities , government (linguistics) , medical diagnosis , medical emergency , family medicine , pediatrics , emergency medicine , pathology , disease , philosophy , social science , linguistics , sociology , economics , economic growth
Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports from 1996 to 2002 found autopsies detected, on average, 23.5% of clinically missed diagnoses involving the principal or underlying cause of death, and 9% of errors that would or could have affected the patient's outcome. We surveyed pathology laboratories and hospital administrators across Australia, and found a decline in the hospital autopsy rate from 21% (210/1000 deaths) in 1992–93 to 12% (118/1000 deaths) in 2002–03. This decrease is in adult autopsies (66% of all autopsies in 1992–93; 39% in 2002–03). Perinatal autopsies increased from 29% to 58% of all autopsies in this period, mainly due to more examinations of fetuses less than 20 weeks’ gestation. Factors contributing to this decline may include community attitudes, clinicians’ reluctance to request autopsy (partly because of administrative burdens in making the request), hospital concern about legal action if a misdiagnosis is detected, and funding priorities. Reversing this decline will require cooperative action at several levels of the healthcare system, and from government bodies.