© 2008 Delmar Cengage Learning. HI Unit 8 Chapters 8 and 10

© 2008 Delmar Cengage Learning. Unit 8 Outcomes Define obstetric related terminology. Calculate obstetric-related rates. Define miscellaneous hospital rates. Calculate miscellaneous hospital rates. 2

© 2008 Delmar Cengage Learning. Unit 8 – To Do List Due 6/14 Read Chapters 8 & 10 in the Koch textbook Complete Self-tests and Chapter Exercises for each chapter read in the Koch text – not graded. Seminar - 20 Points Discussion Board - 20 Points Quiz - 40 Points 3

© 2008 Delmar Cengage Learning. 4 Pregnancy Terms page 140 Delivery –Act of giving birth to a live or dead fetus, including the placenta, single or multiple infants Partum –Childbirth Antepartum –Period before giving birth Postpartum: Period after giving birth

© 2008 Delmar Cengage Learning. 5 Pregnancy Terms Termination –Expulsion or extraction of a dead fetus –Products of conception –Birth of liveborn or stillborn infant Induced termination –Interruption of pregnancy

© 2008 Delmar Cengage Learning. 6 Maternal Terms Page 141 Maternal/obstetrical death –Death of mother while pregnant or within 42 days of termination of pregnancy Direct maternal death –Related to pregnancy or delivery Indirect maternal death –Not related to pregnancy or delivery

© 2008 Delmar Cengage Learning. 7 Cesarean Section Terms Cesarean section rate –Deliveries performed by C-Section compared to vaginal deliveries Vaginal birth after cesarean section (VBAC) rate –Vaginal delivery with previous delivery via c- section

© 2008 Delmar Cengage Learning. 8 Newborn/Fetal Terms Newborn–show signs of life at birth –Born in the hospital –Included in newborn/bassinet statistics Fetal death (abortion, aborted fetus, stillborn)–no signs of life at birth –Not included in newborn/bassinet statistics –Statistically compiled separate

© 2008 Delmar Cengage Learning. 9 Newborn/Fetus Terms Neonate –Liveborn up to 28 days of age Infant –Liveborn up to one year of age

© 2008 Delmar Cengage Learning. 10 Newborn/Fetus Terms Hospital fetal death –No signs of life prior to complete expulsion/extraction –Not considered a hospital inpatient and does not have a medical record. Circumstances of birth would be recorded in the mother’s record. –Not included in newborn statistics

© 2008 Delmar Cengage Learning. 11 Fetus Death Terms American College of Obstetrics and Gynecologists (ACOG) and ICD-9-CM classifications –Early 500 grams or less, before 22 weeks gestation –Intermediate 501 – 1000 grams –Late 1001 grams or more, after 22 weeks gestation

© 2008 Delmar Cengage Learning. Calculating Rates How many times something happened divided by how many times it could have happened. Example – A person is shooting basketball and takes 25 shots at the basket. The ball goes through the hoop 15 times. 15/25 = 0.6 or 60%. He/she successfully completed 60% of the shots. 12

© 2008 Delmar Cengage Learning. 13 Hospital Obstetrics Mortality Rate – page 145 Maternal Death Rate –Ratio of deaths due to pregnancy during a specified period to the number of OB discharges Rate should be low. Computed on an annual basis. See formula and example. Self-Test 8-1, #1

© 2008 Delmar Cengage Learning. 14 Newborn Death Rate Formula–NB death rate: –Numerator Total number of NB deaths for the period  100 –Denominator Total number of NB discharges for the period (including deaths)

© 2008 Delmar Cengage Learning. Chapter 10 Miscellaneous Rates

© 2008 Delmar Cengage Learning. 16 Nosocomial / Community Acquired Infection Page 179 Nosocomial –Originates in a hospital –Includes postoperative infections Community Acquired –an infection contracted outside of a health care setting or an infection present on admission. According to the textbook – what is the distinguishing factor?

© 2008 Delmar Cengage Learning. Hospital Acquired Infections See Link on Left According to the article did rates for nosocomial infections increase or decrease from the year before? 17

© 2008 Delmar Cengage Learning. 18 Nosocomial Infection Rates Numerator: –Number of Noscomial infections Denominator: –Total Number of discharges, including deaths. See Example –Calculate. Is your answer 2.0%?

© 2008 Delmar Cengage Learning. Postoperative Infection – pg. 179 Develops postoperatively. Is also considered a nosocomial infection. Rates are expected to be low. Infections should be rare. See link on left. –What percent of patients who undergo joint replacement surgery have infection. 19

© 2008 Delmar Cengage Learning. 20 Postoperative Infection Rates Postoperative infections –Formula Numerator –Total number of postoperative infections in a clean surgical case. Denominator –Total number of surgical operations

© 2008 Delmar Cengage Learning. Postoperative Infection Rates Surgical Terms – page 180 –What are “clean” surgical cases? In the formula, the denominator is the number of “surgical operations.” –We do not use the number of patients operated on, because a patient can have more than one surgical operation. See Example. Calculate. Answer is 4.0%. Do you come up with that answer? 21

© 2008 Delmar Cengage Learning. Practice – Page 181 Self-Test Careful Hospital Surgical Unit…. Calculate: –A. Nosocomial Infection Rate –B. Postoperative Infection rate 22

© 2008 Delmar Cengage Learning. Complication/Comorbidity In medical coding, these are referred to as CC’s. A secondary diagnosis determined to be a complication or co-morbidity in relationship to the principal diagnosis. 23

© 2008 Delmar Cengage Learning. 24 Complication Rate Complication –Condition that occurs during the hospital stay that extends the length of stay by at least one day in 75 percent of the cases. –Additional disorder arising after admission and affects the course of illness and care Infection, adverse drug reaction, hemorrhage

© 2008 Delmar Cengage Learning. 25 Comorbidity Rate Comorbidity –Differs from complication in that it is a pre- existing condition –Will increase the length of stay at least one day in 75 percent of the cases Diabetes, hypertension, asthma

© 2008 Delmar Cengage Learning. 26 Complication Rate Formula –Numerator Total number of complication for the period  100 –Denominator Total number of patient discharges (including deaths)

© 2008 Delmar Cengage Learning. 27 Comorbidity Rate Formula –Numerator Total number of comorbidities for the period x 100 –Denominator Total number of patient discharges Including deaths

© 2008 Delmar Cengage Learning. Practice – Page 185 Self-Test 10-4 –Rosewood Hospital data in July… –Calculate complication rate. Comorbidity Rate Example –There were 120 comorbidities reported.. –Calculate. –Do you get the answer 12%? 28

© 2008 Delmar Cengage Learning. 29 Bed Turnover Rate Start Bed and bassinet turnover rate –Measure of hospital utilization –Number of times each bed/bassinet changes occupants –Bassinet turnover rate is calculated separate from adult and children

© 2008 Delmar Cengage Learning. 30 Bed Turnover Rate Direct bed turnover rate –Formula Numerator –Total number of discharges (including deaths) for the period Denominator –Average bed count for the period

© 2008 Delmar Cengage Learning. 31 Bed Turnover Rate Indirect bed turnover rate –Formula Numerator –Occupancy rate –In decimal format x number of days in the period Denominator –Average length of stay

© 2008 Delmar Cengage Learning. Unit 8 – To Do List Due 6/14 Read Chapters 8 & 10 in the Koch textbook Complete Self-tests and Chapter Exercises for each chapter read in the Koch text – not graded. Seminar - 20 Points Discussion Board - 20 Points Quiz - 40 Points 32