Improving autopsy rate in a teaching hospital

Factors affecting autopsy rates, autopsy request rates, and autopsy findings at a large academic medical center

Autopsy rates continue to decline in the United States. To assess the impact of various objective factors (time of death, day of death, age at death, patient gender, clinical service, and length of hospital stay) on the autopsy request rate, autopsy rate, successful request rate, and percentage of cases in which the autopsy examination added to or altered the clinical assessment of the patient, we prospectively studied all hospital deaths at a major academic medical center for the 3-year period from 1996 through 1998. The autopsy rate decreases significantly with patient age, both because of a decreasing request rate and because family members are less likely to grant permission. An autopsy is less likely to be requested for deaths in the emergency department or on general surgery services and most likely to be requested for fetal, medicine, cardiothoracic surgery, and pediatric deaths. Families more commonly grant permission for autopsy on fetal deaths, pediatric deaths, and emergency department deaths. Forty percent of autopsies reveal significant information about the patient's death beyond what was known premortem. This is least frequent among the fetal deaths, but relatively constant for adults of all ages. Patients who die in the emergency department are most likely to have significant unexpected findings at autopsy. Increasing the request rate for adult patients who die in the emergency department and on the medicine services will result in the greatest increase in information learned from autopsy.