The Autopsy as a Quality Assurance Tool?

Nowadays the potential purpose of the autopsy is in a much broader range including quality assurance of medical diagnostics and service,  obtaining tissue and organs for transplantation and research, public education,  the development of accurate mortality statistics, the early identification of environmental, infectious and occupational hazards to health,  information documentation for future legal, financial, and medical evaluation, assessment of new forms of therapy and new diagnostic modalities, and continuing education of physicians.

Quality assurance is a planned and systematic approach in monitoring, assessing and improving the quality of health services on a continuous basis within the existing resources . Quality assurance comes in many forms, and may be known as Total Quality Management, Continuous Quality Improvement, Clinical Audit or Quality Circles. Quality of care has different meanings to different stakeholders, in our case doctors and patients. All quality assurance systems should encompass three perspectives on quality: clinical standards, performance management, and client satisfaction.

It has become fashionable for government health policies worldwide to include statements on the quality of their health services. Such statements usually reflect a concern for ensuring that health services are both cost effective and responsive to public needs.

While autopsies have the power to audit some aspects of medical care, no one has yet shown interest to use the autopsy as a quality assurance tool. No data have substantiated the widespread belief that autopsies lead to improvement in patient care, which means that the beneficial effect of autopsies on the quality of care remains a matter of faith. Usually, autopsy reports reside in the shadow of the pathology and medical records departments becoming “orphan data”.

The autopsy is an important tool of quality assurance for all aspects of surgery and medicine and should be regarded as an increasingly critical tool in assessing patient safety issues in the hospital setting.Thus, to ensure that autopsies have an optimal impact on quality of care, the hospitals should be encouraged , through their administrative and medical staffs, to institute policies and identify the responsible people to achieve the following:

  1. Full participation of a representative pathologist in the institutional Quality Care Committee or other staff committee with such designated responsibility ;
  2. Use of a standardized routine to present and analyze diagnostic discrepancies involving rough quantification of the level of the discrepancy ;
  3. Efforts to discover if the discrepancy was necessary or avoidable ;
  4. Elucidation of the circumstances that led to the diagnostic error ;
  5. Rigorous educational efforts to minimize the possibility that similar errors will reoccur ;
  6. Ensure that appropriately trained staff and adequate facilities are available for the performance of autopsies ;
  7. Ensure that professional services for the autopsy are appropriately remunerated. Without compensation, autopsies are often not viewed as the truly valuable medical procedure they are.

For quality assurance purposes, the autopsy should be regarded as a critical service and should be integrated into hospital based quality assurance programs. Moreover, the healthcare system as a whole can thus benefit from autopsy data, by substantially enhancing the accuracy of vital statistics, which play important roles in research, funding, and other policy decisions.