Download Gross autopsy rate

HI-140
Unit 9 Learning Outcomes
Calculate
 Calculate
 Calculate
 Calculate
 Calculate
 Calculate
 Calculate
 Calculate

the gross autopsy rate
the net autopsy rate
the adjusted autopsy rate
fetal death rates
newborn death rates
death rates of inpatients
death rates of outpatients
surgery death rates
1
Unit 9 – To Do List

Read Chapters 7 & 9 in the Koch textbook

Complete Self-tests and Chapter Exercises for each
chapter read in the Koch text. For Practice.

Participate in this Weeks seminar, or do Seminar
Option 2 assignment - 20 Points

Participate in this Weeks Discussion Board
20 Points

Take Week 9 Quiz – 40 Points
2
Terms

Mortality


Incidence of death in a specific
population
Inpatient death

Expired while an inpatient at the
hospital/facility
3
Inpatient/Outpatient Terms –
page 118

Outpatient death
Expired patient during outpatient care
 Do not include:

 Inpatient
deaths
 Emergency department deaths
 Dead on arrival
 Home care or hospice care
 Hospital fetal death (stillborn/abortion)
4
Terms – page 118

Newborn death

Expired infant that has shown signs of life at
the time of birth, born in the hospital, and dies
during the same admission.
Important not to confuse newborn death
with fetal death. (See letter D on page
118)
 Newborn deaths are included in the
hospital death rate, but are calculated
separately.
5

Mortality/Death Rates
 Based
on Discharge Data.
 Remember the term Discharge includes
deaths.
 Includes newborns with adults and
children unless the death rate is for a
specific population
 Includes all inpatient deaths
 Does
not include outpatients and outpatient
deaths
6
Death Rates In General
Formula for any rate is to divided the
number of times something happens by
the number of times it could have
happened.
 Example: 15 patients discharged. Of
these 15, two were deaths and thirteen
were live discharges.


What is the formula for determining the death
rate?
7
Death/Mortality Rates
Page 120

Based on discharge data
Rate is carried out at least 2 decimal places
 Generally less than 1 percent


Two rates:
Gross death rate
 Net death rate

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Gross Rates

Gross


When used statistically refers to the
amount before anything is subtracted
Gross death rate

Number of inpatient deaths, during a
given period, divided by the total
number of inpatient discharges,
including deaths, for the same period
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Gross Death Rate

Formula includes:

Numerator:
 Total
number of inpatient deaths, including NB, for
the period

Denominator:
 Total
number of inpatient discharges, including
deaths, (NB, adults, children) for the period

Critical Care Hospital experienced 21 deaths
(adults, children and newborns), there were
633 discharges (including deaths). What is
the gross death rate?
10
Net Rates – page 120

Net Death Rate
Is an “adjusted” death rate. Patients who die
within 48 hours of admission should not be
counted “against” the hospital.
 Net death rate excludes deaths that occur less
than 48 hours from admission
 Institutional death rate
 Excludes deaths within 48 hours to reflect the
hospital’s ability to save lives

11
Net Death Rate

Total number of inpatient deaths
(including adult, children, NB)
Minus the deaths < 48 hours after admission
for a period 100
 Divided by total number of inpatient
discharges (including adults, children, NB)
 Minus number of deaths < 48 hours after
admission, for the same period.
 See Formula – page 120.

12
Net Death Rate

Formula:

Numerator:
 Total
number of inpatient deaths, (including adults,
children, NB)
 Minus those > 48 hours, for the period  100

Formula:

Denominator:
 Total
number of inpatient discharges, (adults,
children, NB) including deaths
 Minus deaths > 48 hours for the period

See Example – page 121.
Newborn Death Rate
Even though NB death rate is included in
hospital gross and net death rates, may want
to calculate separately.
 Formula - NB death rate:


Numerator:
 Total

number of NB deaths for the period divided by
Denominator:
 Total
number of NB discharges including deaths, for
the period

Move the decimal over two places to the right to
make percent.
Practice Self-Test 7-1 Page 122

1. Calculate
A. Gross death rate
 B. Net death rate
 C. Newborn mortality rate


4. Calculate
A.
 B.
 C.
 D.

Gross death rate for November
Net death rate for November
Newborn Mortality rate for November
Gross death rate for A&C for November
15
Practice Self-Test Page 123

#6. Calculate
A. Gross death rate for June
 B. Net death rate for June
 C. Newborn death rate for June

16
Surgical Death Rate
– page 123
Postoperative Death Rate
 Number of deaths occurring after a
surgical operation:

Referred to as surgical death rate
 Occur within 10 days post-operative

 Divided


by number of patients operated on
Carried out at least two decimal places.
Generally less than one percent
See Formula – top of page 124.
17
Anesthesia Death Rate – page 125

Ratio of deaths caused by anesthetic
agents during a specified period to the
number of anesthetics administered

Formula:
 Total number of deaths caused by
anesthetic agents
 Divided by total number of anesthetics
administered
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Practice Self-Test 7-2
Page 124-125

1. Postoperative Death Rate for July
Page 125
 2. Feel Good Hospital – August


Postoperative Death Rate for August
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Practice
Self-Test 7-3 – page 125
Chastity Hospital
 Calculate:

A. Anesthetic Death Rate for Year
 B. Postoperative Death Rate for Year
 C. Gross Death Rate for surgical
patients for year.
 D. Net death rate for surgical patients
for year.

20
Chapter 7 – Death Rates
In Summary
Include only Inpatient Deaths – exclude
OP, DOA and fetal deaths.
 Death rates should be low.
 Death rates should be carried to 2 -3
decimal places.
 Net death rates exclude deaths less than
48 hours after admission.
 Anesthesia death rates should be extremely
low – calculated on a yearly basis.
21

Chapter 9 Page 158
Autopsy Rates
Autopsy Terms – page 158
Autopsy/necropsy -is the medical
examination of a dead body to determine
the cause of death.
 Useful in the education of Medical Students


Can provide information for family
members (family must give consent, unless
a Coroner’s case)
23
Hospital Autopsy
Hospital Autopsy
A postmortem examination of a person who
at some time had been an patient of the
hospital.
 Includes inpatients, outpatients, and former
patients.




Autopsy performed by the hospital pathologist.
No mention of where the examination is to take
place.
Hospital may not have a pathologist on staff. Still
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included in hospital autopsy rate.
Autopsy –when required?
And who performs?
Page 160
 Can be performed by hospital pathologist,
coroner or medical examiner.
 Varies state by state.
 Coroner/Medical Examiner

 Death
under unusual circumstances with suspicion
of foul play.
 A sudden or suspicious, unexplained or unexpected
death.
 Not autopsied by the hospital pathologist
25
Autopsy –when required?
And who performs?
Medical Examiners and Coroners have specific
jurisdictions which cover only certain kinds of
cases.
 These generally involve sudden, violent, or
unexpected deaths, or deaths related to
accidents or criminal activity.
 MEs or Coroners are not required to do
autopsies on people who have a known
disease process, or are over a certain age and
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die suddenly.

Difference between Medical
Examiner and Coroner

Varies county by county

A medical examiner is required to have a medical
degree, with additional education in pathology and forensic
pathology; this is the primary difference between an ME
and coroner, as a coroner is usually not a physician, nor
trained in medicine or forensic pathology. A medical
examiner is typically an appointed officer.

A coroner is an elected official. Coroners lead
investigations into cause of death, contracting physicians to
perform the actual medical examination.
27
Autopsy Rates

Hospital autopsy rate.



One performed by the hospital’s pathologist.
Percentage of deaths followed by a postmortem exam.
Includes autopsy of all adult/children inpatients,
outpatients, newborn, and former patients
To be included in rate:



Hospital death
Body has not been removed by the coroner or other
circumstances
See page 161 – Coroners Cases
28
Autopsy Rates – page 162

Gross autopsy rate


Ratio of all inpatient autopsies to all inpatient deaths.
Regardless of whether or not they were coroner’s cases (in
the denominator)
Formula
 Numerator

Total autopsies on inpatient deaths for a period  100
 Denominator



Total inpatient deaths for the period, including coroner’s cases.
Includes newborn, adults, children
See Example – bottom of page 162
29
Practice: Self Test 9-2
Page 163

1. In November…


Calculate Gross autopsy rate for November
and Gross Death Rate for November
2. Pleasant Valley Hospital..
See Note
 Calculate Gross Autopsy rate and Gross Death
Rate

30
Net Autopsy Rate –page 164
The bodies of patients who have died are
not always available for autopsy.
 Coroner or medical examiner may claim a
body for an autopsy for legal reasons.
 In Net Autopsy rates, bodies that have
been removed are excluded from the
denominator.

31
Net Autopsy Rates – page 164

Net autopsy rate

Ratio of all inpatient autopsies to all inpatient
deaths
 Inpatient
deaths do not include those autopsied in
coroners/medical examiners’ cases

Formula

Numerator


Total autopsies on inpatient deaths for a period divided by -
Denominator
 Total inpatient deaths for the period
 Includes newborn, adults, children

Minus those not autopsied in coroner’s cases
Practice Self Test 9-3
Page 165

1. Second quarter statistics…


Calculate Net Autopsy Rate and Gross
Autopsy rate
2. Happiness Hospital Data…
Calculate:
 A. Net Autopsy Rate
 C. Gross Autopsy Rate

33
NewBorn Autopsy Rates


Page 169
Newborn autopsy rate. These rates are usually
included in the hospital autopsy rate. But can
be also be calculated separately.

Formula

Numerator


Denominator


Autopsies performed on newborn deaths for the period
Total newborn deaths for the period
See Example – page 169
34
Practice Self-test 9-5
Page 169

1. Newborn figures for October…
Calculate:
 A. Newborn Autopsy Rate
 B. Newborn Death Rate for October

35
Unit 9 – To Do List

Read Chapters 7 & 9 in the Koch textbook

Complete Self-tests and Chapter Exercises for each
chapter read in the Koch text. For Practice.

Participate in this Weeks seminar, or do Seminar
Option 2 assignment - 20 Points

Participate in this Weeks Discussion Board
20 Points

Take Week 9 Quiz – 40 Points
36