The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia

Abstract

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.

An International Survey of Brain Banking Operation and Characterization Practices

“…The operation of these banks is influenced by many factors, including scientific and technological advances, researchers requesting more complex and larger cohorts, and a global decline in autopsy rates. 7 Brain bank networks have developed in different continents (e.g., Australian Brain Bank Network and BrainNet Europe) to enhance collaborations, optimize protocols, and increase the ability to fill researchers' requests for tissue.…”

Reversing the slow death of the clinical necropsy: developing the post of the Pathology Liaison Nurse

“…4 However, despite these and other advantages, the clinical (consented) necropsy has been declining for many years, both in the United Kingdom [5][6][7][8] and in other countries. [9][10][11][12][13][14][15][16][17] Such is its state of decline that it is in danger of dying out completely. 18 In the USA, some hospitals have converted their necropsy facilities into space for other purposes.…”

A platform for discovery: The University of Pennsylvania Integrated Neurodegenerative Disease Biobank

“…Although the number of autopsies worldwide is declining [23,24], families and patients support autopsy-based research altruistically [25–27], and autopsies have a recognized educational and teaching purpose [28]. In addition, still in this century a significant number of autopsies detect clinically important missed diagnoses, although the rate of autopsy-detected diagnostic errors has declined (including nonneurological cause of death) [29].…”