Ensuring Quality in the Hospital Autopsy

Abstract

Despite an unceasing stream of publications extolling the value of postmortem examination (1–12), the hospital autopsy rate continues to decline. Estimates, published in the 199Os, of the overall autopsy rate in the United States are as low as 5%, with the rate in academic institutions estimated at 11% (13,14). Several factors contribute to this. One is the notion that the autopsy will not reveal information above and beyond that gained from current sophisticated imaging studies. Another is the clinicians’ concern about resultant litigation. A more fundamental reason, however, is the lack of vigoron the part of the clinician to seek permission from the family (15). The physician attending the death may be too quickly distracted by other competing concerns and responsibilities, or more likely, (s)he is unfamiliar with the family of the deceased. This latter situation is frequent in teaching hospitals, where a house officer with no prior contact with the patient attends the death and feels uncomfortable in requesting permission for autopsy. These obstacles notwithstanding, it this author’s opinion that any academic teaching hospital must make a genuine and persistent effort to achieve a hospital autopsy rate of at least 25%.