流行病学与卫生统计学课件：Unit 5Hospital Statistics-part II

1、HOSPITAL STATISTICS-PART II Inpatient Death (Mortality) RatesGrossNetAnesthesia Post-operativeMaternalNeonatal and infantDeath CertificatesInpatient deaths: registration process initiated by hospital or nursing home.Coroners cases: registration initiated by funeral director Five days to file report

2、State Health Dept applies certificate number and document becomes a true certificate of death Three signatures are required: Funeral director, Certifier (physician or other), Local RegistrarDeath CertificatesRoute of Death Certificates:hospital or nursing homefuneral homelocal registrarstate registr

3、arstate records are microfilmed and sent to National Center for Health Statistics monthlyUses for a Death Certificate: insurance, estates, wills, data for statistics, plan for future health needsU.S. Death Certificate sampleU.S. Death Certificate sampleDeath (Mortality) Rates Death (Mortality) Rates

4、The hospital death rate is the proportion of inpatient hospitalizations that end in death, usually expressed as a percentageA synonymous term for hospital death rate is gross death rateDeath is a type of discharge or disposition, and should always include in the total dischargesNot include in the ho

5、spital inpatient death rate:Dead on arrival (DOA)Die in the emergency services department (ESD)Die in the hospital while as an outpatient Fetal deaths are not included in the hospital death rate but are calculated separatelyGross Death Rate Total inpatient deaths (Includes newborns) x 100 Total disc

6、harges (including A & C and NB deaths) in the same periodGross Death Rate 35 inpatient deaths (includes newborns) x 100 1275 total discharges = 2.75%Net Death Rate Total number of inpatient deaths (including NB) minus deaths 48 hours for a given period x 100 Total number of discharges (including dea

7、ths) minus deaths 48 hours from the same periodThe net death rate excludes deaths under 48 hours and is less than the gross death rateAlso referred to as the Institutional Death RateNet Death RateCommunity Hospital had 155 discharges, including eight deaths. Three of the deaths were in the hospital

8、less than 48 hours. The net death rate would be: (8 3) x 100 500 = = 3.29% (155 3) 152Postoperative Death Rate Total number of deaths (within 10 days of surgery) x 100 Total number of patients who were operated on for the periodRefers to the number of deaths occurring after an operation has been per

9、formedDeath within 10 days of the surgeryAlso be referred to as the Surgical Death RatePost-operative Death Rate 4 deaths within 10 days of surgery x 100 475 patients operated on= 0.84 %Anesthesia Death RateTotal deaths caused by anesthetics agents x 100Total number of anesthetics administeredThe ra

10、tio of deaths caused by anesthetic agents during a period to the number of anesthetics administeredAnesthesia Death Rate3 anesthetic deaths x 100475 anesthetics administered = 0.63%Maternal Death Rate Number of direct maternal deaths for a period x 100 Number of obstetrical discharges (including dea

11、ths) For the periodThe 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)Maternal Death Rate1 obstetric death x 100245 obstetric patients= 0.41 %U.S. Birth Certificate

12、, sampleU.S. Standard Certificate of Live BirthU.S. Standard Certificate of Live BirthBirth Certificate 出生证Chinese birth certificate新生儿NeonatalChinese definition: 新生儿，指的是宝宝自脐带结扎起，至生后满28天这一段时间。Neonatal period: The period of an infants from the hour of birth through the first 27 days, 23 hours, and 59

13、 minutes of life.Newborn Mortality RateThe following definitions apply to infant deathsNewborn death Refers to the death of a liveborn infant born in the hospital who later dies during the same admissionNeonatal deathThe death of a live-born infant within the period of 27 days, 23 hours, and 59 minu

14、tes from the moment of birthPostneonatal deathThe death of a live-born 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)Newborn Mortality RateThe following definitions apply to infant deathsInfant deathThe death of a l

15、ive-born 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 deathsNewborn Mortality RateA hospital had 2,000 newborn d

16、ischarges and one newborn death in one year, its newborn mortality rate would be (1 x 100) = 0.05% 2,000Total number of newborn deaths for a period x 100Total number of newborn discharges (including deaths) for the periodFetal Death RateFetal deaths may be classified asEarly deathFewer than 20 weeks

17、 of gestation and a weight of 500 grams or less Intermediate deathTwenty completed weeks of gestation (but less than 28 weeks) and a weight of 501 to 1,000 gramsLate deathTwenty-eight completed weeks of gestation and a weight of 1,001 grams or moreBoth intermediate and late fetal deaths constitute w

18、hat is commonly termed a stillbirthFetal Death RateTotal number of intermediate and/or late fetal deaths for a period x 100Total number of live births + intermediate and late fetal deaths for the periodA death prior to the complete expulsion or extraction from the mother (in a hospital facility) of

19、a product of human conception (fetus and placenta) regardless of the duration of pregnancyFetal Death RateDuring June, a hospital had 100 live births, one intermediate fetal death, and three late fetal deaths. The fetal death rate for the hospital would be:(4 x 100)400 = = 3.846% = 3.85%(100 + 4) 10

20、4GrossNetAdjustedHospital Autopsies and Autopsy RatesGross Autopsy Rate Total autopsies on inpatient deaths for a period x 100 Total inpatient deaths for the periodRatio during any given period of time of all inpatient autopsies to all inpatient deathsNewborn autopsies are included in the gross auto

21、psy rateThey may be calculated separately as determined by your medical staff committeesGross Autopsy Rate12 inpatient autopsies x 100 65 inpatient deaths= 18.46 %Net Autopsy Rate Total autopsies on inpatient deaths for a period x 100 Total inpatient deaths minus Unautopsied coroners or medical exam

22、iners casesRatio during any given period of time of all inpatient autopsies to all inpatient deaths, minus unautopsied coroners or medical examiners casesNet Autopsy Rate12 inpatient autopsies x 100 65 inpatient deaths - 3 medical examiners cases = 19.35 %Adjusted Hospital Autopsy Rate Total hospita

23、l autopsies x 100 Total number of deaths of hospital patients whose bodies are available for hospital autopsyProportion of hospital autopsies performed following the deaths of patients whose bodies are available for autopsyAdjusted Autopsy Rate16 autopsies x 10065 inpatient deaths + 1 DOA + 3 deaths

24、 in ED= 23.19 %Newborn Autopsy Rate Newborn autopsies for a period X 100 Total newborn deaths for the periodProportion of hospital autopsies performed following the deaths of newbornsNewborn Autopsy RateCommunity Hospital had 27 births during the month of September. One newborn died shortly after bi

25、rth and was autopsied. The Newborn autopsy rate is: 1 x 100= 100% 1Morbidity and Other Miscellaneous RatesInfectionsNosocomial infection Acquired in the hospitalCan be attributable toSpecific patient care units (PCUs)Specific operationsPatients with specified diseaseMedical staff unitsIndividual phy

26、siciansHospital employees 45Additional morbidityProlonged hospitalizationLong-term physical, developmental and neurological damageIncreased cost of hospitalizationDeathConsequences of Nosocomial Infections46Areas of interest to a hospital epidemiologistSurveillance for nosocomial infectionbloodstrea

27、m infectionspneumoniaurinary tract infectionssurgical wound infectionsPatterns of transmission of nosocomial infectionsOutbreak investigationIsolation precautionsEvaluation of exposuresEmployee healthDisinfection and sterilizationHospital engineering and environmentwater supplyair filtrationReviewin

28、g policies and procedures for patient careInfection RateRatio of all infections to the number of discharges including deaths Total number of infections x 100 Total number of discharges (including deaths) for the periodInfection Rate (8 infections x 100)= 5.33%150 discharges (including deaths) Cesare

29、an SectionDeliveryprocess of delivering a liveborn infant or dead fetus (and placenta) by manual, instrumental, or surgical means (Horton, page 123)A woman may be admitted to the hospital for a condition of her pregnancy, however, she may not deliver her infant during that hospitalizationFor example, a patient who is admitted in labor but later discovered that this is an instance of false la