Calculating & Reporting Healthcare Statistics

Second Edition Chapter 6 Death (Mortality) Rates

Death (Mortality) Rates

The hospital death rate is the proportion of inpatient hospitalizations that end in death, usually expressed as a percentage A synonymous term for hospital death rate is gross death rate

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Death (Mortality) Rates

Important information for health agencies and hospitals in evaluating the quality of medical care Death rate information is also used by a variety of other industries
Researchers use death rates to show causes of death in certain populations

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Death (Mortality) Rates

Formula for Calculating Gross Death Rate
Number of inpatient deaths (including NB) in a period x 100/ Number of discharges (including deaths) in the period

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Death (Mortality) Rates

Death is a type of discharge or disposition
Any data representing total discharges include deaths for that period. Thus, deaths are always assumed to be included in the total discharges in the denominator unless otherwise specified.

If deaths of newborn inpatients are included in the numerator, all discharges of newborn inpatients must be included in the denominator.
Ordinarily, newborns are included in the gross death rate unless a facility chooses to calculate their rate separately.

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Death (Mortality) Rates

Patients who are dead on arrival (DOA) are not included in the gross death rate because DOAs are not admitted to the hospital. Patients who die in the Emergency Services Department (ESD) are not included in the gross death rate because they were not admitted to the hospital. Patients who die in the hospital while as an outpatient are not included in the gross death rate.

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Death (Mortality) Rates

Fetal deaths are not included in the gross death rate but are calculated separately Because death rates are ordinarily small, the calculation should be carried out to two decimal places
It is a good idea to put a zero in front of the decimal (for example, 0.23%) to show the casual observer that the rate is less than one percent

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Net Death Rate

The net death rate excludes deaths under 48 hours and is less than the gross death rate Requested by various reporting or accrediting agencies Also referred to as the Institutional Death Rate

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Net Death Rate

Formula
Total number of inpatient deaths (including NB) minus deaths < 48 hours for a given period x 100 / Total number of discharges (including deaths) minus deaths < 48 hours from the same period

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Postoperative Death Rate

Refers to the number of deaths occurring after an operation has been performed
Within 10 days after surgery

Also may be referred to as the Surgical Death Rate

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Postoperative Death Rate

This involves the ratio of deaths within ten days after surgery to the total number of patients operated on during the period
Surgical operation = one or more surgical procedures performed at one time for one patient via a common approach or for a common purpose Surgical procedure =any single, separate, systematic process upon or within the body that can be complete in itself; is normally performed by a physician, dentist, or other licensed practitioner; can be performed either with or without instruments; and is performed to restore disunited or deficient parts, remove diseased or injured tissues, extract foreign matter, assist in obstetrical delivery, or aid in diagnosis

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Postoperative Death Rate

This may also be calculated by specific operations
For example:
Coronary artery bypass grafts Bowel resection Cholecystectomy

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Postoperative Death Rate

Formula
Total number of deaths (within 10 days of surgery) x 100 / Total number of patients who were operated on for the period

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Anesthesia Death Rate

The ratio of deaths caused by anesthetic agents during a period to the number of anesthetics administered Because anesthesia deaths occur infrequently, some hospitals might choose, instead, to evaluate the relationship between a death and a specific anesthetic for a special study

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Anesthesia Death Rate

Three major types of anesthesia
General
Puts the entire body to sleep

Regional
Removes the ability to feel any pain or sensations in a specific region of the body
Spinal and epidural anesthesia are examples

Local
Numbs a small area of the body

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Anesthesia Death Rate

Formula
Total deaths caused by anesthetics agents x 100/Total number of anesthetics administered

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Maternal Death Rate

The death of any woman, from any cause, related to or aggravated by pregnancy or its management (regardless of duration or site of pregnancy, but not from accidental or incidental causes)
An example of an accidental death could include a motor vehicle accident or a fall down a flight of stairs An incidental death could include a suicide or homicide

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Maternal Death Rate

Direct versus Indirect obstetric death
Direct obstetric death is directly related to the pregnancy
For example, a patient died after a C-section because of a nick to the uterine artery which resulted in hemorrhage

An indirect obstetric death is not directly due to obstetric causes, even though the physiologic effects of pregnancy are partially responsible for the death
For example, diabetes

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Maternal Death Rate

When this rate is computed, hospitals usually classify only direct obstetric deaths as maternal deaths and include only those deaths that occur during hospitalization

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Maternal Death Rate

Formula
Number of direct maternal deaths for a period x 100/Number of obstetrical discharges (including deaths) for the period

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Maternal Death Rate

Includes prepartum not delivered and postpartum cases
Prepartum = occurring prior to childbirth
For example, a patient who comes into the hospital in labor, but does not deliver and is discharged home

Postpartum = occurring after childbirth

For example, a patient who comes into the hospital after delivery with an infection of the C-section incision site

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Newborn Mortality Rate

The following definitions apply to infant deaths
Neonatal death
The death of a liveborn infant within the period of 27 days, 23 hours, and 59 minutes from the moment of birth

Postneonatal death
The death of a liveborn infant from 28 days of birth to the end of the first year of life (through 364 days, 23 hours, 59 minutes from the moment of birth)

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Newborn Mortality Rate

Infant death
The death of a liveborn infant at any time from the moment of birth to the end of the first year of life (through 364 days, 23 hours, 59 minutes from the moment of birth) Perinatal death An all-inclusive term referring to both stillborn infants and neonatal deaths

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Newborn Mortality Rate

Formula
Total number of newborn deaths for a period x 100/Total number of newborn discharges (including deaths) for the period

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Fetal Death Rate

A death prior to the complete expulsion or extraction from the mother (in a hospital facility) of a product of human conception (fetus and placenta) regardless of the duration of pregnancy
The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles The reporting of fetal deaths varies according to individual state laws, statutes, and regulations

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Fetal Death Rate

Fetal deaths are not considered patient deaths They are not included in any calculation of deaths but calculated separately Determination of whether to include fetal death data in a specific hospitals statistics requires an investigation of the facilitys needs by hospital administration, medical staff, and reporting agencies

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Fetal Death Rate

Fetal deaths may be classified as
Early death
Fewer than 20 weeks of gestation and a weight of 500 grams or less

Intermediate death
Twenty completed weeks of gestation (but less than 28 weeks) and a weight of 501 to 1,000 grams

Late death
Twenty-eight completed weeks of gestation and a weight of 1,001 grams or more

Both intermediate and late fetal deaths constitute what is commonly termed a stillbirth

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Fetal Death Rate

Formula
Total number of intermediate and/or late fetal deaths for a period x 100/Total number of live births + Intermediate and late fetal deaths for the period

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Cancer Mortality Rate

Measures the risk of death for the cause under study in a defined population during a given time period Formula
Number of cancer deaths during a period x 100,000/Total number in population at risk

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