They also can reveal diagnostic discrepancies
Autopsies can detect clinically important diagnostic discrepancies and help an organization improve the quality of care, according to a new report released by the Agency for Healthcare Research and Quality (AHRQ).
Based on an analysis of more than 50 studies spanning 40 years, researchers estimate that, in U.S. hospitals in the year 2000, the correct cause of death escaped clinical detection in between 8% and 23% of cases, with as many as 4% to 8% of all deaths having a diagnostic discrepancy that may have harmed the patient. In addition to clinically missed diagnoses, up to 5% of autopsies disclosed clinically unsuspected complications of care.
These diagnostic discrepancy rates do not simply reflect selection by clinicians of diagnostically challenging cases, according to the AHRQ. In fact, considerable evidence suggests that clinicians have trouble predicting which autopsies are likely to yield important new information. The researchers note that, although often referred to as "diagnostic errors," these findings refer to discrepancies between clinical diagnoses and autopsy diagnoses and not necessarily to medical mistakes. While diagnostic discrepancies can result from a clinician’s failure to consider an appropriately broad listing of alternative diagnoses or misinterpretation of test results, there also are situations with atypical symptoms or limited diagnostic test information, they explained. These discrepancies, regardless of source, create inaccuracies in death certificates and hospital discharge data, both of which play important roles in epidemiologic research and health care policy decisions, the study authors said.
The evidence report examined the benefits of the autopsy as a tool in health care performance measurement and improvement. However, the researchers did not attempt to address other roles of the autopsy in medical education, furthering medical research, quality control within the medical specialty of pathology, verification of second opinion consultations and legal documentation of findings, or the bereavement process for surviving family members. The focus of the report on the autopsy’s role in detecting quality problems reflected an objectively quantifiable area to evaluate the potential negative effects of the trend toward fewer autopsies during the past 40 years.
In 1994, the last year for which national data exist, the autopsy rate for all nonforensic deaths fell below 6%, from a high of 50% in the 1960s. This decline is probably due to lack of reimbursement for autopsies, the attitudes of clinicians regarding the utility of autopsies in light of other diagnostic advances, and general unfamiliarity with the autopsy and techniques for requesting one, especially among physicians in medical training, according to the study authors.
The report was requested by the College of American Pathologists. A summary of the report can be found on-line at www.ahrq.gov/clinic/epcsums/autopsum.htm.
Autopsies can detect clinically important diagnostic discrepancies and help an organization improve the quality of care, according to a new report released by the Agency for Healthcare Research and Quality (AHRQ).
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