The Autopsy Crisis Reexamined: The Case for a National Autopsy Policy

Hill, Rolla B.; Anderson, Robert E.

doi:10.2307/3350121

Cited by 12 publications

(8 citation statements)

References 31 publications

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“…While autopsies conceptually contribute to auditing of aspects of medical care, to the best of our knowledge, no studies have shown that conducting autopsies and publicizing the findings are directly beneficial for patients [ 22 ]. No data have substantiated the notion that autopsy practice improves quality of patient care.…”

Section: Autopsies As Quality Management Toolmentioning

confidence: 99%

“…In spite of this lack of an evidence base, many clinicians and pathologists have experienced the teaching effect of an unexpected autopsy diagnosis, which may be beneficial for many patients to come, however difficult this might be to measure. Most commonly, autopsy reports reside in the obscurity of pathology and medical records departments as orphan data, because they are not systematically evaluated [ 22 ].…”

Section: Autopsies As Quality Management Toolmentioning

confidence: 99%

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The medical autopsy as quality assurance tool in clinical medicine: dreams and realities

Tweel

Wittekind

2015

Virchows Arch

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The purpose of medical autopsy has changed to issues of quality assurance today. In addition, autopsies are considered valuable in medical education, e.g., delivering cases for problem-based learning for students. Many studies underscore the need for autopsies also in the era of technical progress emphasizing the continuing discrepancies between antemortem and post mortem diagnoses. Despite these important tasks, we face a decline of autopsy for several reasons with complex interactions. The role of all persons involved in this decline is evaluated and suggestions for changes are proposed. Last but not least, the future of the autopsy is in the hands of pathology itself.

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Section: Autopsies As Quality Management Toolmentioning

confidence: 99%

Section: Autopsies As Quality Management Toolmentioning

confidence: 99%

The medical autopsy as quality assurance tool in clinical medicine: dreams and realities

Tweel

Wittekind

2015

Virchows Arch

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“…There are no data to support the widespread belief that autopsies lead to improvements in patient care (33). This could mean that belief in the qualitative importance of autopsies really is a "matter of faith," and that doubters can cite a lack of evidence.…”

Section: Measuring the Quality Effects Of Autopsymentioning

confidence: 98%

Post-Mortem Examination as a Quality Improvement Instrument

Wittekind¹,

Gradistanac²

2018

Deutsches Ärzteblatt International

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ver since G. B. Morgagni (1) first showed the scientific value of autopsies, many reasons have arisen for carrying out autopsies over the centuries (2). Despite the manifold indications for autopsy, however, over the past few decades autopsy rates have been falling all over the world, and so they have in Germany. Opinions vary as to what lies behind this drop in autopsy rates. Our own experience, based on many interviews and conversations, suggests that many doctors, especially young ones, believe that clinical findings and causes of death can be adequately investigated using available clinical diagnostic techniques, so that autopsies have become unnecessary. This view is contradicted, however, by many publications showing that discrepancies continue to exist between pre-mortem and post-mortem diagnoses. In this article, we discuss alternatives to the "classical" autopsy. The clinical autopsy: definition and indicationsA clinical autopsy is a macroscopic medical examination by a physician of (if possible) all three body cavities of a deceased person, supplemented by clinical information relating to the medical history, cause of death, and clinical questions (Box 1).Discrepancies between pre-mortem and postmortem diagnoses are of varying significance for the treatment of the patient and are usually classified according to the Goldman criteria (3): • Class I error: Misdiagnosis that may have affected survival and probably would have required alteration of treatment • Class II error: Misdiagnosis that did not affect survival and would not have required alteration of treatment • Class III and class IV errors: Missed minor diagnoses unrelated to the disease course Discrepancies between pre-mortem and postmortem diagnosesSince 1912, up to 2002 and even later, numerous studies have shown considerable differences between pre-and post-mortem diagnoses (Table 1) (4-13, e2-e5).In 2003, a literature search by Shojania et al. ( 14) for the period 1966 to 2002 identified a total of 45 studies (53 different autopsy series). Irrespective of methodological problems, which they discussed, these authors reached the following conclusions: On average, the rate of class I errors was 9% (range: 0 to Summary Background: Autopsies are considered an important quality assurance instrument in medicine, yet autopsy rates in many countries have been declining for many years. The proper role of the post-mortem examination in modern medicine is a matter deserving of study.Methods: This review is based on a selective search of the literature for publications on the role of autopsies as a quality assurance instrument.Results: Multiple studies have revealed substantial rates of discrepancy between pre-and post-mortem diagnoses, with reported rates lying in the range of 10% to 40%. The frequency of so-called Goldman I erroneous diagnoses, i.e., those that are determined at autopsy and might have influenced the patient's survival, ranges from 2.4% to 10.7%. It can be assumed that the rate of serious diagnostic errors revealed by autopsy would fall i...

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“…The legal regulation of post-mortem clinical training practice is thus often included in autopsy legislations [71] Quality control of public statistics Being considered "gold standard" for cause of death, autopsy results are used for correction of public statistics [72]. Low autopsy rates worldwide endanger adequate distribution of funding of various diseases [73,74] Tissue sampling and research Autopsies remain a major source for sampling of fluids, cells, and tissues. As a substitute for the full, conventional post-mortem, f.e.…”

Section: Training In Medical Proceduresmentioning

confidence: 99%

Code of practice for medical autopsies: a minimum standard position paper for pathology departments performing medical (hospital) autopsies in adults

et al. 2021

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The medical autopsy (also called hospital or clinical autopsy) is a highly specialised medical procedure, which requires professional expertise and suitably equipped facilities. To ensure high standards of performance, the Working Group of Autopsy Pathology of the European Society of Pathology (ESP) suggests a code of practice as a minimum standard for centres performing medical autopsies. The proposed standards exclusively address autopsies in adults, and not forensic autopsies, perinatal/or paediatric examinations. Minimum standards for organisation, standard of premises, and staffing conditions, as well as minimum requirements for level of expertise of the postmortem performing specialists, documentation, and turnaround times of the medical procedure, are presented. Medical autopsies should be performed by specialists in pathology, or by trainees under the supervision of such specialists. To maintain the required level of expertise, autopsies should be performed regularly and in a number that ensures the maintenance of good practice of all participating physicians. A minimum number of autopsies per dedicated pathologist in a centre should be at least 50, or as an average, at least one autopsy per working week. Forensic autopsies, but not paediatric/perinatal autopsies may be included in this number. Turnaround time for final reports should not exceed 3 weeks (14 working days) for autopsies without fixation of brain/spinal cord or other time-consuming additional examinations, and 6 weeks (30 working days) for those with fixation of brain/spinal cord or additional examinations.

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The Autopsy Crisis Reexamined: The Case for a National Autopsy Policy

Cited by 12 publications

References 31 publications

The medical autopsy as quality assurance tool in clinical medicine: dreams and realities

The medical autopsy as quality assurance tool in clinical medicine: dreams and realities

Post-Mortem Examination as a Quality Improvement Instrument

Code of practice for medical autopsies: a minimum standard position paper for pathology departments performing medical (hospital) autopsies in adults

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