1. HI-140 Unit 9 Learning Outcomes
Calculate the gross autopsy rate
Calculate the net autopsy rate
Calculate the adjusted autopsy rate
Calculate fetal death rates
Calculate newborn death rates
Calculate death rates of inpatients
Calculate death rates of outpatients
Calculate surgery death rates

2. 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

3. Terms Mortality Inpatient death
Incidence of death in a specific population
Inpatient death
Expired while an inpatient at the hospital/facility

4. 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)

5. 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.

6. 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

7. 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?

8. 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

9. Gross Rates Gross Gross death rate
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

10. 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?

11. 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

12. 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.

13. Net Death Rate Formula: See Example – page 121. Numerator:
Total number of inpatient deaths, (including adults, children, NB)
Minus those > 48 hours, for the period  100
Denominator:
Total number of inpatient discharges, (adults, children, NB) including deaths
Minus deaths > 48 hours for the period
See Example – page 121.

14. 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.

15. Practice Self-Test 7-1 Page 122
1. Calculate
A. Gross death rate
B. Net death rate
C. Newborn mortality rate
4. Calculate
A. Gross death rate for November
B. Net death rate for November
C. Newborn Mortality rate for November
D. Gross death rate for A&C for November

16. 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

17. 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.

18. 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

19. 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

20. 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.

21. 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.

22. Chapter 9 Page 158
Autopsy Rates

23. 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)

24. 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 included in hospital autopsy rate.

25. 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

26. 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 die suddenly. 

27. 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.

28. Autopsy Rates Hospital autopsy rate. To be included in 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

29. Autopsy Rates – page 162 Gross autopsy rate Formula
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

30. 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

31. 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.

32. Net Autopsy Rates – page 164
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

33. 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

34. NewBorn Autopsy Rates See Example – page 169 Page 169
Newborn autopsy rate. These rates are usually included in the hospital autopsy rate. But can be also be calculated separately.
Formula
Numerator
Autopsies performed on newborn deaths for the period
Denominator
Total newborn deaths for the period
See Example – page 169

35. Practice Self-test 9-5 Page 169
1. Newborn figures for October…
Calculate:
A. Newborn Autopsy Rate
B. Newborn Death Rate for October

36. 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