TECHNICAL NOTE 1 PERINATAL DEATHS PROCESS IMPROVEMENT


INTRODUCTION

1 Perinatal deaths comprise all fetal deaths (of at least 20 weeks gestation or at least 400 grams birth weight), and all neonatal deaths (all live born babies who die within 28 completed days of birth, regardless of gestation or birth weight). Fetal deaths are only included in the perinatal deaths collection. However, neonatal deaths are included in both the perinatal deaths and the causes of death collections.

2 In order to complete a perinatal death registration, the death must be certified by either a doctor using the Certificate of Cause of Perinatal Death, or by a coroner. It is the role of the coroner to investigate the circumstances surrounding all reportable deaths and to establish wherever possible the circumstances surrounding the death, and the cause(s) of death. For perinatal deaths, most deaths due to external causes and suspected Sudden Infant Death Syndrome will be referred to a coroner for investigation.

3 Table 1 shows the proportion of perinatal deaths certified by a doctor or a coroner. In 2008, 4.4% (109) of all perinatal deaths were certified by a coroner rather than by a doctor.

Table 1: Deaths by type of Certifier and state/territory of registration - 2007 and 2008(a)
	Doctor (2007)		Coroner (2007)		Total (2007)(b)	Doctor (2008)		Coroner (2008)		Total (2008)(b)
	no.	%	no.	%	no.	no.	%	no.	%	no.
NSW	737	97.5	19	2.5	756	731	95.1	38	4.9	769
Vic.	605	97.9	13	2.1	618	560	96.6	20	3.4	580
Qld	610	93.0	31	4.7	656	602	95.9	26	4.1	628
SA	126	94.0	8	6.0	134	129	97.7	4	3.0	132
WA	194	98.0	4	2.0	198	248	95.4	12	4.6	260
Tas.	55	94.8	4	6.9	58	58	95.1	4	6.6	61
NT	52	98.1	3	5.7	53	29	87.9	1	3.0	33
ACT	58	98.3	1	1.7	59	35	92.1	1	2.6	38
Australia	2 437	96.2	80	3.2	2 532	2 392	95.6	109	4.4	2 501
(a) Data cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. It is important to note that cells with a zero value have not been affected by confidentialisation.
(b) Total includes 'blank', 'not stated' and 'not applicable'.

4 When coronial investigations are complete, causes of death information is passed to the Registrar of Births, Deaths and Marriages, as well as to the National Coroners Information System (NCIS). The ABS uses the NCIS as the only source of data to code coroner certified deaths. Where a case remains open on the NCIS at the time the ABS ceases processing and insufficient information is available to code a cause of death (e.g. a coroner certified death was yet to be finalised by the coroner), less specific ICD codes are assigned as required by the ICD coding rules.


PROCESS IMPROVEMENT

5 The specificity with which open cases are able to be allocated an ICD-10 code is directly related to the amount and type of information available on the NCIS. The amount of information available for open cases varies considerably from no information to detailed police, autopsy and toxicology reports.

6 For 2008, increased resources and time were spent investigating coroners reports to identify specific causes of death. This involved making increased use of police reports, toxicology reports, autopsy reports and coroners findings for both open and closed cases to minimise the use of non-specific causes and intents. This has resulted in improved data quality enabling more specificity in assigning cause codes to coroner certified deaths.

7 In 2008, there were 63 (58%) perinatal cases with an open or not stated case status on NCIS which may not have had information available at the time of processing. However, all open cases were subject to the new process improvement and use was made of any available police reports, toxicology reports, autopsy reports or coroners findings. On a jurisdictional level, the proportion of cases which have a status of open on the NCIS varies. This means that the impact of the new process improvement has varied across states and territories.

8 For 2007 revised data, there were 35 (44%) perinatal cases with a status of 'open' or 'other' on NCIS which have not yet been subject to the process improvement. These cases will go through this process as part of the next revisions process. See Technical Note 2: Revisions Process for further information.

Table 2: Coroner certified perinatal deaths, by case status and state of registration - 2007 and 2008(a)
	Open	Closed	Other(b)	Total
2008
New South Wales	11	25	3	38
Victoria	13	6	4	20
Queensland	12	2	12	26
Other states and territories(c)	10	13	2	25
Australia	46	46	17	109
2007
New South Wales	4	14	2	19
Victoria	7	6	-	13
Queensland	5	14	12	31
Other states and territories(c)	6	11	-	17
Australia	22	45	13	80
- nil or rounded to zero (including null cells)
(a) Data cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. It is important to note that cells with a zero value have not been affected by confidentialisation.
(b) 'Other' includes cases with status of 'blank', 'not stated' and 'not applicable'.
(c) 'Other states and territories' includes South Australia, Western Australia, Tasmania, Northern Territory and Australian Capital Territory.

9 Further information on the impact of process improvements to 2008 causes of death data can be found in Technical Note 1: 2008 COD Collection - Process Improvements in Causes of Death, Australia, 2008 (3303.0).