Calculating & Reporting Healthcare Statistics Second Edition Chapter 7 Hospital Autopsies and Autopsy Rates

Autopsy Examination of dead body to determine the cause of death Performed in order to educate physicians and allied health professionals Can be performed on the entire body or a particular body organ Other names Necropsy Postmortem (after death) examination ©2006 All rights reserved.

Autopsy Generally conducted by Performed in the hospital morgue The hospital pathologist, or A physician on the medical staff who has been delegated with this responsibility Performed in the hospital morgue Some small hospitals do not have a morgue and the body may be removed to an off site lab or funeral home ©2006 All rights reserved.

Gross Autopsy Rate Ratio during any given period of time of all inpatient autopsies to all inpatient deaths The rate is customarily reported as a percentage Newborn autopsies are included in the gross autopsy rate They may be calculated separately as determined by your administration or medical staff committees ©2006 All rights reserved.

Gross Autopsy Rate Formula Total autopsies on inpatient deaths for a period x 100/Total inpatient deaths for the period ©2006 All rights reserved.

Net Autopsy Rate Ratio during any given period of time of all inpatient autopsies to all inpatient deaths, minus unautopsied coroners’ or medical examiners’ cases The formula for net autopsy rate differs slightly from the one for gross autopsy rate in that it excludes coroners’ or medical examiners’ cases that are not autopsied at the hospital ©2006 All rights reserved.

Net Autopsy Rate There are certain types of deaths that are reportable to the coroner A coroner is an official (elected or appointed; physician or non-physician) who is responsible for determining the cause of death in unattended, violent or unexplained deaths The term coroner comes from the Old English “corono” which means crown – and a coroner was appointed by the English crown In some parts of the country the coroner is called the medical examiner or ME If a body is released to the coroner it would not be available for autopsy by the hospital pathologist ©2006 All rights reserved.

Net Autopsy Rate Formula Total autopsies on inpatient deaths for a period x 100/Total inpatient deaths minus Unautopsied coroners’ or medical examiners’ cases ©2006 All rights reserved.

Hospital Autopsies Hospital inpatient autopsy Postmortem examination performed in a hospital facility on the body of an inpatient who died during hospitalization In contrast - hospital autopsy Postmortem examination, wherever performed, of the body of a person who has at some time been a hospital patient This may include Emergency patients Outpatients Home health patients Or others that have been former patients ©2006 All rights reserved.

Hospital Autopsies Guidelines Usually, hospital autopsies are performed by the staff pathologist Responsibility for performing autopsies may be delegated to another physician in small facilities Normally, hospital autopsies are performed in hospitals Autopsies can be performed in another designated place for small facilities This is the only case where outpatients are included with inpatient statistics Fetal autopsies are not included in the hospital autopsy rate A fetus is not considered a patient The autopsy report must be filed in the patient’s health record The tissue specimens must be filed in the hospital laboratory along with the autopsy report ©2006 All rights reserved.

Adjusted Hospital Autopsy Rate Proportion of hospital autopsies performed following the deaths of patients whose bodies are available for autopsy Although many hospitals calculate the net autopsy rate for various surveys and external reports, the adjusted hospital autopsy rate is a more accurate indication of the hospital’s resources for physician education because it includes all autopsies ©2006 All rights reserved.

Adjusted Hospital Autopsy Rate Formula Total hospital autopsies x 100/Total number of deaths of hospital patients whose bodies are available for hospital autopsy ©2006 All rights reserved.

Adjusted Hospital Autopsy Rate Patients whose bodies are available for hospital autopsy include Inpatient deaths (unless the bodies are removed from the hospital by legal authorities such as coroners) If the hospital pathologist or delegated physician performs an autopsy while acting as an agent of the coroner, the autopsy is included in the numerator and the death in the denominator of the adjusted hospital autopsy rate formula Other patients including Hospital home care patients Outpatients Previous hospital patients who have died elsewhere whose bodies have been made available for the performance of hospital autopsies ©2006 All rights reserved.

Newborn Autopsy Rate Proportion of hospital autopsies performed following the deaths of newborns ©2006 All rights reserved.

Newborn Autopsy Rate Formula Newborn autopsies for a period X 100/Total newborn deaths for the period ©2006 All rights reserved.

Fetal Autopsy Rate Proportion of hospital autopsies performed following the deaths of intermediate and late fetal deaths ©2006 All rights reserved.

Fetal Autopsy Rate Formula Autopsies performed on intermediate and late fetal deaths for a period x 100/Total intermediate and late fetal deaths for the same period ©2006 All rights reserved.