The Death of the Hospital Autopsy

Autopsies ― sometimes called the ultimate medical audit ― were an integral part of American healthcare a half-century ago and were performed on roughly half of all patients who died in hospitals. Up until 1971, the Joint Commission required that community hospitals perform autopsies on 20 percent of inpatient deaths, increasing to 25 percent for teaching facilities, as part of earning accreditation. Although hospitals are still required to develop criteria for autopsies, and should “attempt to secure autopsies in all case of unusual death” and in cases of “medical, legal, educational interest,” it is rare today when a hospital has an autopsy rate of more than 5% for nonforensic deaths according to data from the Centers for Disease Control and Prevention. Some pathology experts say it is usually only about 1%.

SOME REASONS FOR THE DECLINE

There are a number of reasons why the rate of autopsies has declined including:

  • Hospitals are not required to offer or perform autopsies and view autopsies as a financial drain; Medicare and insurers do not pay for autopsies either.
  • Some facilities and doctors shy away from them, fearing they may reveal malpractice.
  • Getting consent from the family is difficult without making anyone suspicious that the surgeon or intensive care unit did something wrong, the diagnosis was incorrect, or the clinical trial failed.

Still, in study after study, autopsies have revealed that physicians make a high rate of diagnostic errors even with increasingly sophisticated imaging equipment and new technologies.

LOOKING TO THE FUTURE

Pathologists and public health officials are starting to recognize that there may be broader consequences as a result of low autopsy rates in the U.S. as the nation focuses on reducing medical errors and improving the quality of care. Diagnostic errors, which studies show are common, can go undiscovered, allowing physicians to practice on other patients with a false sense of security. Opportunities are lost to learn about the effectiveness of medical treatments and the progression of diseases. Inaccurate information winds up on death certificates, undermining the reliability of crucial health statistics. In a 2002 review of academic studies, the federal Agency for Healthcare Research and Quality found that when patients were autopsied, major errors related to the principle diagnosis or underlying cause of death were found in one of four cases. In one of ten cases, the error appeared severe enough to have led to the patient’s death. However, some pathologists estimate that 30-40 percent of the time, autopsies reveal something unknown about the patient’s disease or condition that could have affected the course of care. Autopsies are much more revealing than an MRI or CT ― with which some hospitals have replaced the traditional autopsy.

FACILITY IMPACT

As autopsies continue to be viewed as a financial drain for a healthcare organization, many hospitals today do not even include autopsy suites when they are building new facilities and may have no place to store bodies ― either contracting with a university or a private service or requiring the funeral home to come directly to the floor to pick up the deceased patient. Unfortunately, autopsy facilities are expensive to build and even if there is a shift to performing autopsies on a higher percent of patient deaths, it is likely that the service will still be outsourced to a nearby university of private service.

This article is an update of a previous post.