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The quality of medical autopsy reports
Background:
Medical autopsies are rarely made subject to quality assurance. We have investigated the quality of autopsy reports in Norway and assessed the impact of errors on the cause of death statistics.
Material And Method:
Every fifth medical autopsy report for adults (> 2 years) in 2014 was reviewed. The significance of the autopsy result for the registration of cause of death was studied by comparing the death certificate issued by the clinician with the coding in the Cause of Death Registry after the autopsy.
Results:
A total of 389 autopsy reports from 15 departments of pathology were reviewed. The autopsy request, as well as the death certificate and the codes for the cause of death from the Cause of Death Registry were available for 339 and 360 cases respectively. Ninety-five requests had specified clinical questions, but were commented on by the pathologist in 33 cases. Obesity was rarely reported as a finding, even in cases of pathological deviations from a normal weight. A post-mortem virus examination or toxicology had been performed in 1 and 28 autopsies respectively. The average turnaround time for autopsies without and with a neuropathological examination was 99 and 138 days respectively. Errors in reporting the cause of death or inadequate reporting were evident in 69 cases (18 %), most frequently for deaths from cardiovascular diseases. The autopsy result led to a change to the cause of death in the Cause of Death Registry in 206 out of 360 (57 %) cases for which coding data were available. Errors in the formulation of the autopsy result resulted in erroneous coding of the cause of death in 22 out of 47 (47 %) of cases with errors.
Interpretation:
The proportion of autopsy reports with errors in the formulation of the cause of death was unexpectedly high and may have consequences for the cause of death statistics. Long turnaround times for autopsies complicate communication with the clinician about the findings.
Insights
Medical autopsy reports in Norway show a high error rate, impacting cause of death statistics. Improving autopsy quality is crucial for accurate vital records.
Area of Science:
- Forensic Pathology
- Medical Statistics
- Quality Assurance in Healthcare
Background:
- Medical autopsies typically lack robust quality assurance processes.
- There is a need to evaluate the quality of autopsy reports and their influence on cause of death data.
Purpose of the Study:
- To investigate the quality of medical autopsy reports in Norway.
- To assess the impact of errors in autopsy reports on cause of death statistics.
Main Methods:
- A review of every fifth medical autopsy report for adults (over 2 years old) from 2014.
- Comparison of clinician-issued death certificates with Cause of Death Registry coding post-autopsy.
Main Results:
- 18% of 389 reviewed autopsy reports contained errors in cause of death reporting, particularly for cardiovascular diseases.
- Autopsy findings led to a change in the registered cause of death in 57% of cases.
- Errors in autopsy reports resulted in incorrect cause of death coding in 47% of cases with reporting errors.
Conclusions:
- The high proportion of errors in autopsy reports may significantly affect cause of death statistics.
- Extended autopsy turnaround times hinder effective communication between pathologists and clinicians.
