The Death of the Hospital Autopsy

By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Spring-Summer 2014
www.spacemed.com

BACKGROUND
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, or
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% if
at all.
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 they 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 10 cases, the error appeared severe enough
to have led to the patients death. However, some pathologists estimate that 30-40
percent of the time, autopsies reveal something unknown about the patients 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.

2014.7.2

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www.spacemed.com

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The Death of the

Hospital Autopsy
Continued

FACILITY IMPACT
Autopsy facilities in a hospital typically include an autopsy room with work counter, hand-washing station, an autopsy table, storage space, and a deep sink for
washing specimens, a body holding refrigerator with temperature monitoring and
alarm signals, and an environmental service room with a housekeeping service
sink. 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 minimal body holding facilities 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 or a private service.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.

2014.7.2

Copyright SpaceMed

www.spacemed.com

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