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Although discharges include deaths, this chapter is concerned with the percentage of deaths that occur during inpatient hospitalization.

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True

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are deaths that occur during a patients inpatient hospitalization.

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Inpatient deaths

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are those that occur to patients being treated by the hospital's medical staff but not during the term of the patient's inpatient stay.

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Outpatient deaths

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The patient who dies during outpatient treatment or an outpatient procedure.

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Outpatient death

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treated in the Emergency department of the medical center, unable to be revived, or expires during treatment, and is not included in inpatient death rates.

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Unresponsive patient (outpatient death)

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it is common to combine the two sets of data, unless the A&C or newborn rate is specified.

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When computing death rates,

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can be important in identifying causes of death and bringing attention to their causes.

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Death rates

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It may be that a community is seeing an increase in handgun deaths or an increase in cancers due to the environment which may spark community action.

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Death rates

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it may also be determined that certain ethnic populations have an increased risk of dying due to certain conditions which can be addressed.

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Death rates

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Not all deaths are preventable but the inpatient death rate should be low.

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True

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refers to death or being fatal----a fatality. A mortal is subject to death or is destined to die.

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Mortality

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are death rates

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Mortality rates

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a patient who expires while being an inpatient in a hospital is an inpatient death. An inpatient death indicates the patient expired after admission as an inpatient but prior to being discharged during the same hospitalization.

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Inpatient death

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A newborn death occurs only in infants who have signs of life at the time of birth.

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Newborn Death

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Therefore, any infant or fetus born dead is a fetal death----never a newborn death.

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Newborn Death

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Any sign of life, no matter how tenuous, results in a live newborn.

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Live Newborn

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Should the newborn expire, even minutes after birth, the newborn, and is included in inpatient death rates.

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Newborn Death

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It is important not to confuse newborn deaths with fetal deaths.

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True

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1). Patients who expire while receiving care (treatment, a procedure on an outpatient basis. Also included, 2). Patients receiving care on a continuing outpatient basis by a member of the medical staff. 3). A hospice patient receiving care at home, and considered an outpatient, and who expires at home is an out patient death.

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Outpatient Death

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are recorded but not included in inpatient statistics.

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Outpatient Deaths

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ER deaths and DOA .

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Outpatient Deaths

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is death prior to complete expulsion or extraction from its mother, in a hospital facility, of a product of human conception--fetus and placenta--respective of the duration of the pregnancy and without any signs of life.

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Hospital Fetal Deaths

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are never included in hospital mortality rates, except separate fetal death rates.

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Hospital Fetal Deaths

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it represents an amount before anything is subtracted. Such as "gross pay".

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Gross Is Used Staistically

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the gross pay is the amount you would have received prior to any taxes and insurance taken out by your employer.

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Gross Is Used Staistically

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If an employee is hired to work 40 hrs. a week at the rate of $10.00 per hour, the employee actually is earning $400.00 a week

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Gross Is Used Staistically

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is the deductions taken out of a pay check due to federal and state incomes, social security tax, health insurance, retirement fund, etc.) taken out by the employee's net pay

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Net Rate Used Statistically

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a gross death rate and a net death rate.

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There Are To primary Inpatient Death Rates

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there will be deaths subtracted from gross death rates. Gross minus something = net.

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When Calculating Net Death Rates

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Discharge data include all patients who died during their inpatient hospitalization.

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Death Rates

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In general, discharge data include deaths but should the term live precede the word discharges--live discharges--the reader will have to add the deaths to the live discharges to derive at the total discharges.

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Death Rates

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When computing all rates, keep in mind that all rates are the ratio of the of the number of times something happens to the number of times it could happen. If 15 patients were discharged on January 20 and 2 were deaths, then 13 were live discharges.

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Death Rates

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In previous calculations, high percentages were considered advantageous. A hospital hopes to have high census figures, inpatient service data, and high occupancy percentages. The opposite should hold true for death rates. A result of 90% or even 20% would clearly indicate a miscalculation and alert the statistician to look for errors. In many instances a death rate will be less than 1% resulting in a decimal figure (e.g. 0.67%. Carefully check the placement of the decimal point in computing death rates. A misplaced decimal point can make a huge difference.

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Death Rates Should Be Low--Helpful Hints

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This will result in a death rate correct to two (at least one) decimal places. A tenth of a percent of a small number. Since death rates will typically be low, calculations should be carried out farther than the calculations introduced up to this point.

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Death Rates Should Be Carried to Three -at Least Two)-Decimal places--Helpful Hints

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Remember, as long as a patient is hospitalized, there is a chance the patient may die. Discharge data are used unless noted in the appropiate death rate.

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Death Rates Generally Use Discharge Data--Helpful Hints

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Death rates for each patient category (A&C and /NB) are also calculated, but in the majority of cases they are combined. This is in contrast to chapter: 7 to census data and occupancy percentages.

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Most Death Rates Combine Newborn and Adult and Children Data

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Formula for Gross Death Rate- Total number of IP deaths (including NB) for a period _________________________________ Total number of Discharges (including deaths) for a period (NB and A&C)

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GROSS DEATH RATE

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If 200 patients were discharged in March and of these, three (3) died, the result is the death rate of 1.5% (3 divided by 200 = 0.015 x 100 = 1.5%.

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EXAMPLE OF GROSS DEATH RATE

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Also referred to as Institutional Death Rate Formula for Net Death Rate: Total IP deaths--including NB-minus deaths under 48 hrs.- for a period ___________________________________ Total discharges- including NB minus deaths under <48 hours for a period.

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NET DEATH RATE

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It was thought, historically, that a patient who expires within the first 48 hours of admission, had insufficient time to be diagnosed and respond to treatment for a life threatening disorder and that only emergency and stabilizing treatment could be provided during such a short period of time. For this reason, the net death rate or institutional death rate came to use. The feeling was that the net death rate reflected more accurately the hospital's ability to save lives.

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NET DEATH RATE

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Today, the net death rate has lost its significance but is still requested by some reporting or accredited services.

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NET DEATH RATE

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may be reviewed by the medical staff committee, especially unexpected deaths.

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Hospital Unexpected Deaths

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Procedures and appropiate patient care may be reviewed in hopes of saving lives in the future. This plays in an important role that hospital statistics can play in addition to the role in aiding administrative decisions.

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Hospital Statistics

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Statistics are important for peer review and better patient care.

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Hospital Statistics

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Not all hospitals use the net death rate, it is assumed the gross death rate is to be used unless otherwise indicated.

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True

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Because net deaths exclude deaths under <48 hours in the numerator, they must be excluded in the denominator.

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True

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EXAMPLE: A total of five patients expired in June, of which two died less than 48 hours following admission. A total of 450 inpatients were discharged in June. The gross death rate includes all deaths (5) divided by the total discharges (450) for a result of 0.011. Converted to a percentage, the gross death rate is 1.1%.

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Gross Death Rates-

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EXAMPLE: The net death rate subtracts two deaths from both the numerator and denominator (5-2 divided by 450 - 2), resulting in a ratio of 3/448 or 0.0067, multiplied by 100, the net death rate computes to 0.67%

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Net Death Rates

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Formulae for Newborn Death Rate: This formula applies to newborns alive in the hospital who expire during admission. Total number of NB deaths--for a period ______________________________ Total number of NB discharges-including deaths for a period

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NEWBORN DEATH RATE

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A NB death has already been described--alive at the time of birth and born during the same admission in which the birth occurred.

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Note For NB Deathrate

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includes newborns under 28 days of age. No fetal deaths are included.

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Neonatal Death

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To determine the newborn death rate, two deaths are placed in the numerator with 104 discharges in the denominator. The newborn death rate is 1,92%, 2/104 = 0.0192 x 100 = 1,92%

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EXAMPLE: A total of two newborns died in December. There were a total of 102 live newborn discharges (104 total discharges).

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Two surgical death rates--post operative and anesthesia death rates are not based on discharges and therefore are exception to the rates discussed.

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Surgical Death Rates

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are not computed by all hospitals.

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Surgical Death Rates

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When referencing surgical data, it should be pointed out that there is a difference between surgical procedure and surgical operation.

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Surgical Death Rates

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is one or more surgical procedures performed at one time for one patient using a common approach or a common purpose.

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Surgical Operation

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is a single manipulation that can be complete by itself.

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Surgical Procedure

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Example: A patient undergoing heart bypass surgery not only has an incision made in the chest but, in addition, a vein is removed from another part of the body--such as the leg. Although two incisions were made, it is one operation.

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Surgical Operation

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Example: A closed reduction to align a broken bone is a procedure, as is a forceps delivery of a fetus.

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Surgical Procedure

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A patient going through a splenectomy an open reduction for a broken wrist following an accident, is undergoing two surgical operations.

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Surgical Operation

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are the postoperative death rate and anesthesia death rate.

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Surgical Death Rates

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It is included here because it is still used frequently by some hospitals. Determining death rates for specific operations can provide more valuable information.

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Postoperative Death Rate

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Determining the number of patients who expire as the result of cholecystectomy or hemicolectomy can be more meaningful than stating the postoperative death rate was 3%.

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Postoperative Death Rate

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In addition, very few surgical patients nowadays are still hospitalized 10 days postop except patients in critical condition or patients who develop major complications.

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Postoperative Death Rate

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Formula for Postoperative Death Rate: In this formula only patients operated on during the 10-day period are patients operated on during the 10-day period are patients whom the formula applies. This is in accordance with the stated rate formula--the number of times a death occurs to the number of times it could happen. Total surgical deaths-within 10 days postoperative for a period ______________________________________________ Total patients operated upon for the period

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POSTOPERATIVE DEATH RATE

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Note: The formula is an exception to the rule of dividing by the number of discharges

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Postoperative Death Rate

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Patients that expire later in the postoperative period- greater than 10 days are considered most likely to have died as the result of a medical condition rather than because of complications due to surgery.

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True

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Example: A total of 3 postoperative deaths, within 10 days postoperative were reported in March. During the same period of time, 375 patients underwent an operative procedure. Using the above formula, 3 deaths are placed in the numerator and 375 in the denominator- patients operated on. The computation is 3/375 = 0.008 x 100 = 0.08% postoperative death rate.

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Postoperative Death Rate

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occur infrequently and the rate is generally only computed annually. Because it is difficult to prove a death occurred by a anesthetic agent, these deaths can only be determined by a physician.

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Anesthesia Death Rate

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When keeping statistics on anesthesia deaths, it may be more meaningful to classify them by specific anesthetic agents- local and general.

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Anesthesia Death Rate

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Formulae for Anesthetic Death Rate: Total deaths caused by anesthetic agents for a period ____________________________________________ Total number of anesthetics administered for a period

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ANESTHETIC DEATH RATE

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are deaths occurring during a patient's hospitalization as an inpatient, prior to discharge.

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Inpatient Deaths

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a). In the Emergency room prior to inpatient hospitalization. b). In outpatients. This includes series patients who return routinely for treatment such as chemo., radiotherapy, rehabilitation, etc., or outpatient therapy. c). In home care or hospice patients seen routinely in their homes.

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Outpatient Deaths are Deaths that occur: to inpatient hospitalization.

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a).outpatient deaths b). ER deaths, c). DOA's, d). fetal death.

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Deaths NOT included in routine death rates include

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are combined, included in the same death rate. Separate rates may also be determined but they are frequently combined.

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A&C and NB deaths

question

is the total number of deaths pertaining to that rate.

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The numerator in all death rates

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a). Include only inpatient deaths---exclude OP's DOA's, and fetal deaths. b). Death rates can be low. c). Death rates should be carried to two or three decimal places. d). Gross and net death rates include discharges in the denominator.

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Helpful Hints:

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exclude deaths occurring less than <48 hours after admission.

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Net Death Rates

question

include only deaths less than 10 days postoperative.

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Postoperative death rates

question

are based on the number of patients operated on.

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Postoperative death rates

question

should be extremely low and are generally on computed on a yearly basis and are based on the number of anesthetics administered.

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Anesthesia death rates

question

a). Gross death rates: Deaths divided by discharges. b). Net death rate: Deaths minus any deaths under 48 hours divided by discharges minus deaths under <48 hrs. c). Newborn death rate: NB deaths divided by NB discharges. d). Postoperative death rate: Postop deaths within 10 days postop divided by the number of patients operated on. e). Anesthesia death rate: Anesthesia deaths divided by the number of anesthetics administered.

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Rates:

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a). Gross death rate: None b). Net Death rate: Deaths under 48 hours. c). Postoperative death rate: Deaths within 10 days of the postoperative period. e). Anesthesia death rates: None.

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Which inpatient deaths are excluded inn each of the following death rates: ;

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Postoperative death rates and anesthesia death ratio.

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Which death rates include something other than discharges in the denominator? /indicate the statistic used in place of discharges:

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Net death rate.

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Which death rate is also called an institutional death rate:

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No, not unless the A&C and NB rates are specified.

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Do most death rates separate newborn from A&C deaths?

Chapter: 8 (Hospital Mortality Rates) – Flashcards

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