This document discusses various autopsy rates used in hospitals including gross, net, adjusted hospital, newborn, and fetal autopsy rates. It defines what an autopsy is and provides formulas for calculating each type of autopsy rate. Key information includes that a gross autopsy rate includes all inpatient autopsies over all inpatient deaths, while a net rate excludes cases removed by coroners or medical examiners. An adjusted hospital rate reflects autopsies performed on bodies available to the hospital. Newborn and fetal rates reflect autopsies only on those types of deaths.

1. © 2019 AHIMA
ahima.orgahima.org
Calculating and Reporting
Healthcare Statistics, Sixth Edition
Chapter 7:
Hospital Autopsies and
Autopsy Rates

2. © 2019 AHIMA
ahima.org
Learning Objectives
• Identify alternate terms for autopsy
• Recognize a coroner’s case and determine when it
would be included in a hospital’s autopsy rate
• Calculate the following autopsy rates: gross, net,
adjusted hospital, newborn, and fetal
• Utilize software to complete spreadsheets
2

3. © 2019 AHIMA
ahima.org
Autopsy
• Examination of dead body to determine the cause
of death
• Performed in order to educate physicians and allied
health professionals
• An autopsy can be performed on the entire body or
a particular body organ
• Other names
• Necropsy
• Postmortem (after death) examination

4. © 2019 AHIMA
ahima.org
Autopsy (continued)
• Generally conducted by
• The hospital pathologist, or
• By a physician on the medical staff who has been delegated
with this responsibility
• Performed in the hospital morgue
• Some small hospitals do not have a morgue and the body may
be removed to an off site lab or funeral home

5. © 2019 AHIMA
ahima.org
Gross Autopsy Rate
• Ratio during any given period of time of all
inpatient autopsies to all inpatient deaths
• The rate is customarily reported as a percentage
• Newborn autopsies are included in the gross autopsy
rate
• They may be calculated separately as determined by your
medical staff committees

6. © 2019 AHIMA
ahima.org
Gross Autopsy Rate
• Formula
𝐺𝑟𝑜𝑠𝑠 𝑎𝑢𝑡𝑜𝑝𝑠𝑦 𝑟𝑎𝑡𝑒 =
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑎𝑢𝑡𝑜𝑝𝑠𝑖𝑒𝑠 𝑖𝑛 𝑖𝑛𝑝𝑎𝑡𝑖𝑒𝑛𝑡 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑜𝑟 𝑎 𝑝𝑒𝑟𝑖𝑜𝑑
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑝𝑎𝑡𝑖𝑒𝑛𝑡 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑜𝑟 𝑎 𝑝𝑒𝑟𝑖𝑜𝑑

7. © 2019 AHIMA
ahima.org
Net Autopsy Rate
• This is the ratio during any given period of time of
all inpatient autopsies to all inpatient deaths, minus
unautopsied coroners’ or medical examiners’ cases
• The formula for net autopsy rate differs slightly
from the one for gross autopsy rate in that it
excludes coroners’ or medical examiners’ cases that
are not autopsied at the hospital

8. © 2019 AHIMA
ahima.org
Net Autopsy Rate (continued)
• There are certain types of deaths that are reportable to
the coroner
• A coroner is an official (elected or appointed; physician or
nonphysician) who is responsible for determining the cause of
death in unattended, violent, or unexplained deaths
• The term coroner comes from the Old English “corono,” which
means crown—and a coroner was appointed by the English
crown
• In some parts of the country, the coroner is called the medical
examiner, or ME
• A physician specializing in pathology or forensic medicine
• If a body is released to the coroner or medical examiner, it
would not be available for autopsy by the hospital pathologist

9. © 2019 AHIMA
ahima.org
Net Autopsy Rate
• Formula
𝑁𝑒𝑡 𝑎𝑢𝑡𝑜𝑝𝑠𝑦 𝑟𝑎𝑡𝑒
=
𝑇𝑜𝑡𝑎𝑙 𝑎𝑢𝑡𝑜𝑝𝑠𝑖𝑒𝑠 𝑜𝑛 𝑖𝑛𝑝𝑎𝑡𝑖𝑒𝑛𝑡 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑜𝑟 𝑎 𝑝𝑒𝑟𝑖𝑜𝑑
𝑇𝑜𝑡𝑎𝑙 𝑖𝑛𝑝𝑎𝑡𝑖𝑒𝑛𝑡 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑜𝑟 𝑎 𝑝𝑒𝑟𝑖𝑜𝑑 − [𝐶𝑎𝑠𝑒𝑠 𝑟𝑒𝑚𝑜𝑣𝑒𝑑 𝑏𝑦 𝑐𝑜𝑟𝑜𝑛𝑒𝑟 𝑜𝑟 𝑚𝑒𝑑𝑖𝑎𝑙 𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑟]

10. © 2019 AHIMA
ahima.org
Hospital Autopsies
• Hospital inpatient autopsy
• Postmortem examination performed in a hospital facility
on the body of an inpatient who died during
hospitalization
• In contrast, hospital autopsy
• Postmortem examination, wherever performed, of the
body of a person who has at some time been a hospital
patient. This may include
• Emergency patients
• Outpatients
• Home health patients
• Others that have been former patients

11. © 2019 AHIMA
ahima.org
Hospital Autopsies (continued)
• Guidelines
• Usually, hospital autopsies are performed by the staff
pathologist
• Responsibility for performing autopsies may be delegated to
another physician in small facilities
• Normally, hospital autopsies are performed in hospitals
• Autopsies can be performed in another designated place for
small facilities
• This is the only case where outpatients are included with
inpatient statistics

12. © 2019 AHIMA
ahima.org
Hospital Autopsies (continued)
• Guidelines (continued)
• Fetal autopsies are not included in the hospital autopsy
rate
• A fetus is not considered a patient
• There must be consent to perform the autopsy
• The autopsy report must be filed in the patient’s health
record
• The tissue specimens must be filed in the hospital
laboratory along with the autopsy report

13. © 2019 AHIMA
ahima.org
Adjusted Hospital Autopsy Rate
• This rate is the proportion of hospital autopsies
performed following the deaths of patients whose
bodies are available for autopsy
• Although many hospitals calculate the net autopsy
rate for various surveys and external reports, the
adjusted hospital autopsy rate is a more accurate
indication of the hospital’s resources for physician
education because it includes all autopsies

14. © 2019 AHIMA
ahima.org
Adjusted Hospital Autopsy Rate (continued)
• Formula
𝐴𝑑𝑗𝑢𝑠𝑡𝑒𝑑 ℎ𝑜𝑠𝑝𝑖𝑡𝑎𝑙 𝑎𝑢𝑡𝑜𝑝𝑠𝑦 𝑟𝑎𝑡𝑒
=
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎ𝑜𝑠𝑝𝑖𝑡𝑎𝑙 𝑎𝑢𝑡𝑜𝑝𝑠𝑖𝑒𝑠
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑏𝑜𝑑𝑖𝑒𝑠 𝑡ℎ𝑎𝑡 𝑎𝑟𝑒 𝑎𝑣𝑎𝑖𝑙𝑎𝑏𝑙𝑒 𝑓𝑜𝑟 𝑎𝑢𝑡𝑜𝑝𝑠𝑦

15. © 2019 AHIMA
ahima.org
Adjusted Hospital Autopsy Rate
• Patients whose bodies are available for hospital autopsy
include:
• Inpatient deaths (unless the bodies are removed from the
hospital by legal authorities such as coroners)
• If the hospital pathologist or delegated physician performs an
autopsy while acting as an agent of the coroner, the autopsy is
included in the numerator and the death in the denominator of
the adjusted hospital autopsy rate formula

16. © 2019 AHIMA
ahima.org
Adjusted Hospital Autopsy Rate (continued)
• Other patients including
• Hospital home care patients
• Outpatients
• Previous hospital patients who have died elsewhere whose
bodies have been made available for the performance of hospital
autopsies

17. © 2019 AHIMA
ahima.org
Newborn Autopsy Rate
• Proportion of hospital autopsies performed
following the deaths of newborns

18. © 2019 AHIMA
ahima.org
Newborn Autopsy Rate (continued)
• Formula
𝑁𝑒𝑤𝑏𝑜𝑟𝑛 𝑎𝑢𝑡𝑜𝑝𝑠𝑦 𝑟𝑎𝑡𝑒 =
𝑁𝑒𝑤𝑏𝑜𝑟𝑛 𝑎𝑢𝑡𝑜𝑝𝑖𝑒𝑠 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑝𝑒𝑟𝑖𝑜𝑑
𝑇𝑜𝑡𝑎𝑙 𝑛𝑒𝑤𝑏𝑜𝑟𝑛 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑝𝑒𝑟𝑖𝑜𝑑

19. © 2019 AHIMA
ahima.org
Fetal Autopsy Rate
• Proportion of hospital autopsies performed
following the deaths of intermediate and late fetal
deaths

20. © 2019 AHIMA
ahima.org
Fetal Autopsy Rate (continued)
• Formula
𝐹𝑒𝑡𝑎𝑙 𝑎𝑢𝑡𝑜𝑝𝑠𝑦 𝑟𝑎𝑡𝑒
=
𝐴𝑢𝑡𝑜𝑝𝑠𝑖𝑒𝑠 𝑝𝑒𝑟𝑓𝑜𝑟𝑚𝑒𝑑 𝑜𝑛 𝑖𝑛𝑡𝑒𝑟𝑚𝑒𝑑𝑖𝑎𝑡𝑒 𝑎𝑛𝑑 𝑙𝑎𝑡𝑒 𝑓𝑒𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑝𝑒𝑟𝑖𝑜𝑑
𝑇𝑜𝑡𝑎𝑙 𝑖𝑛𝑡𝑒𝑟𝑚𝑒𝑑𝑖𝑎𝑡𝑒 𝑎𝑛𝑑 𝑙𝑎𝑡𝑒 𝑓𝑒𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑝𝑒𝑟𝑖𝑜𝑑