Clinical Autopsy As An Outcome Measure And Tool For Quality Improvement At The Cape Coast Teaching Hospital

Abstract

Objective: We set out to investigate, the relationship between the antemortem clinical diagnosis and the clinical autopsy diagnosis, as a tool to assess the quality of health care in our institution.

Methodology: A retrospective review of clinical records of hospital autopsies done in the Cape Coast Teaching Hospital from 1^st January 2011 to 31^st December 2014 was conducted. An analysis of the ante mortem diagnosis and the autopsy diagnosis was conducted by the Departments of Internal Medicine and Therapeutics, Community Medicine, and Pathology of the School of Medical Sciences, Cape Coast Teaching Hospital. Discrepancies were identified and classified according to the Goldman criteria as major missed diagnosis and minor missed diagnosis.

Results: Fifty hospital autopsy cases were reviewed. There was no error in 20(40 %) of the cases. Of the 30 cases (60%) had discrepancies and were classified using the Goldman criteria,12 out of the 30 (40%) were major class I type errors, 15(50 %) were major class II type errors and and the remaining 3(10%) were minor class IV type errors. The diseases were categorized into: others (causes of death that could not be categorized under either infections, cancers, cardiovascular disease, pregnancy related and metabolic) 15 (30%), infections 14 (28%) and cancers 10 (20%) were commonly autopsied, and most were from the medical ward.

Conclusion: Significant discrepancies between the ante-mortem clinical diagnosis and the autopsy diagnosis at the Cape-Coast Teaching Hospital were identified. No statistically significant relationship was found between clinical departments and ACD/AD discrepancy or between category of disease and ACD/AD discrepancy.