High autopsy rates at a university medical center. What has gone right?

OBJECTIVE

Identification of factors that contribute to a high autopsy rate at our institution.

DESIGN

An objective analysis of the Autopsy Service's organization, functions, and process flow to identify factors that impact the autopsy rate.

SETTING

The University of Texas Medical Branch at Galveston, Tex.

METHODS

Statistics were collected using the autopsy log book and computerized data bank. The events starting at the time of a patient's death through the completion of the autopsy report were reviewed. The role of each significant event was analyzed.

RESULTS AND CONCLUSIONS

The annual autopsy rates between 1981 and 1995 ranged between 45% and 59%. The largest number of nonmedicolegal autopsies were received from the Department of Internal Medicine. The Texas Department of Criminal Justice Hospital contributed the largest number of medicolegal autopsies. We conclude that the following key factors contribute to our high autopsy rates: (1) the organization and multiple functions of the Autopsy Service, particularly the presence of a Decedent Affairs Office, dedicated resident assignments, and internal and external quality control of the autopsies; (2) close interactions with clinicians, including timely communication of autopsy results to clinicians and a fostering of positive attitude among clinical residents and faculty; and (3) other factors such as the contributions to hospital risk management, disproving the idea that there may be increased litigation related to high autopsy rates, and support by the hospital administration.