© Copyright Cengage Learning 2015 Chapter 10 Autopsy Rates

© Copyright Cengage Learning 2015 Autopsy Terms Autopsy –Inspection and partial dissection of a dead body to learn the cause of death and the nature and extent of disease –Postmortem examination Hospital autopsy –A postmortem examination performed either by a hospital pathologist or by a physician on the medical staff to whom the responsibility has been delegated on the body of a person who has at some time been a hospital patient. –These patients include inpatients, outpatients, and former patients. 2

© Copyright Cengage Learning 2015 Autopsy Terms Hospital inpatient autopsy –A postmortem examination on the body of a patient who died during inpatient hospitalization –The examination is performed by a hospital pathologist or a physician on the medical staff to whom the responsibility has been delegated. –If an inpatient is a coroner’s case, but the body is autopsied by the hospital pathologist, it is still credited as a hospital autopsy. –Only if the body is removed by the coroner and the body is unavailable for autopsy is it excluded. 3

© Copyright Cengage Learning 2015 Autopsy Terms Hospital outpatient autopsy –An outpatient who dies during outpatient treatment, followed by an autopsy performed by a member of the hospital staff, is included in the hospital autopsy rate (adjusted). 4

© Copyright Cengage Learning 2015 Autopsy Terms Former patient autopsy –A former patient is a patient who has received treatment by the hospital’s medical staff as an inpatient or outpatient in the past, but not currently undergoing treatment. –If the body is autopsied by the hospital pathologist, it is included in the hospital autopsy rate (adjusted). 5

© Copyright Cengage Learning 2015 Autopsy Terms Coroner –Duly elected or appointed official. –Primary function is to investigate any death in which the cause of death is uncertain or due to other than natural causes. –An inquest before a jury may be part of the inquiry. –The investigation is directed at determining the manner, means, and cause of death. 6

© Copyright Cengage Learning 2015 Autopsy Terms Medical Examiner –A physician (most commonly a pathologist). –Officially authorized by a governmental unit (city, county) to ascertain the causes of death, especially those not occurring under natural circumstances. –Not all jurisdictions have a coroner and a medical examiner. –In other than major urban areas, the medical examiner’s job may be performed by the hospital pathologist or another designated physician on the medical staff at the request of the coroner. 7

© Copyright Cengage Learning 2015 Autopsy Terms Coroner’s cases –Deaths reportable to the coroner’s office include deaths due to: Criminal or violent means (homicide) Suicides, suspected suicides Sudden deaths Suspicious or unusual circumstances Accidents, including those which occur on the job –Deaths under the jurisdiction of the coroner’s office include deaths due to blows, burns, crushing, cuts or stab wounds, drowning, electric shock, explosions, firearms, etc. 8

© Copyright Cengage Learning 2015 Autopsy Terms Each state has its own laws regarding deaths reportable to the coroner, and it is important that health care practitioners are knowledgeable about the laws in the state in which they are practicing. 9

© Copyright Cengage Learning 2015 Autopsy Terms The “gross autopsy rate” and the “net autopsy rate” include only inpatient deaths autopsied by the authorized hospital physician. Only the “hospital autopsy rate” includes autopsies performed on inpatients, outpatients, and former patients. A patient who expired in the ER and whose body is autopsied, is included in only the “hospital autopsy rate.” 10

© Copyright Cengage Learning 2015 Autopsy Terms All references to deaths reportable to the coroner will be called “coroner’s cases” and, unless specifically indicated, will be those cases not autopsied by the designated physician on the hospital’s medical staff, and claimed by the coroner. 11

© Copyright Cengage Learning 2015 Who Performs an Autopsy? A hospital autopsy is performed by the hospital’s designated physician, most commonly the pathologist. If the death is a coroner’s case and the coroner is not a medical examiner, the coroner contracts with a physician to perform the autopsy. A physician performs the autopsy, but the circumstances of the death are investigated by the coroner’s office. If the physician hired by the coroner is the hospital’s pathologist and the patient was a hospital patient, the autopsy is included in hospital autopsy rates. 12

© Copyright Cengage Learning 2015 Autopsy Abbreviations Used –HP: an autopsy performed by the hospital pathologist –Cor: coroner’s case Site for Performing an Autopsy –most hospitals have a morgue where the dead bodies are taken to at the time of death –if on-site facilities are not provided, a designated place is specified for carrying out the autopsy 13

© Copyright Cengage Learning 2015 Deaths Autopsied Inpatients. Any inpatient who expires during hospitalization is a potential autopsy case. Outpatients. Only one autopsy rate (hospital autopsy rate) includes autopsies on outpatients. Former Patients. Some autopsies are performed on patients previously treated at the hospital, either as inpatients or outpatients. These patients may include hospice or home care patients. Only one autopsy rate (hospital autopsy rate) includes autopsies on former patients. 14

© Copyright Cengage Learning 2015 Deaths Autopsied Fetal deaths are never included or combined with other groups in any statistical formula and are excluded from all autopsy rates. Fetal autopsies, however, are reported separately and included in a “fetal autopsy rate.” 15

© Copyright Cengage Learning 2015 Deaths Autopsied Coroner’s Cases. Deaths reportable to the coroner may or may not be included, depending on who performs the autopsy. If the hospital pathologist performs the autopsy at the request of the coroner, the autopsy is included with the other autopsies; otherwise the autopsy is excluded. 16

© Copyright Cengage Learning 2015 Report Requirements Whenever a hospital autopsy is performed, a report must be filed in the patient’s medical record and the hospital laboratory. Tissue specimens from the patient must also be placed on file in the hospital, usually, the hospital laboratory. 17

© Copyright Cengage Learning 2015 Consent Consent required for autopsy. A physician obtains permission from the patient’s next of kin to perform an autopsy. The autopsy is performed prior to the release of the body to the funeral home. Consent is not required for autopsy. A consent is not required for a coroner’s case. 18

© Copyright Cengage Learning 2015 Combining A&C with NB As with death rates, autopsy rates combine adults/children (A&C) with newborns (NB). 19

© Copyright Cengage Learning 2015 Gross Autopsy Rates Total autopsies performed on IP deaths for a period Total IP (A&C and NB) deaths 20 × 100

© Copyright Cengage Learning 2015 Net Autopsy Rate Total autopsies (performed on IP deaths) for a period Total IP deaths − Unautopsied cases released to the coroner for a period 21 × 100

© Copyright Cengage Learning 2015 Net Autopsy Rate Net refers to the exclusion (subtraction) of certain patients. In this formula, the cases released to legal authorities (coroner/ medical examiner) are excluded as they are not available for hospital autopsy and the cases are subtracted from the total inpatient deaths (in the denominator). However, should the coroner authorize the hospital pathologist to carry out the autopsy, it is included and therefore not subtracted (in the denominator). Only cases unavailable for autopsy by the hospital’s designated physician are excluded. Also, no outpatients or former patients are included in a net autopsy rate. 22

© Copyright Cengage Learning 2015 Hospital Autopsy Rate (Adjusted) Total number of hospital autopsies for a period Total number of deaths of hospital patients whose bodies are available for hospital autopsy for the period This is the only autopsy rate that includes inpatients, outpatients, and former patients autopsied by the hospital pathologist or by a designated member of the medical staff. 23 × 100

© Copyright Cengage Learning 2015 Newborn Autopsy Rate Autopsies performed on NB deaths for a period Total NB deaths for the period 24 × 100

© Copyright Cengage Learning 2015 Fetal Autopsy Rate Autopsies performed on (intermediate and late) fetal deaths for a period Total (intermediate and late) fetal deaths for the period 25 × 100