Improving quality of discharge summaries and clinical coding in Paediatrics

Quality Improvement Poster Download

Background & Problem

Clinical coding is the translation of medical terminology written by clinicians into a coded format. Codes are used for epidemiological purposes, audit, determining service provision and to ensure departments are paid accurately for clinical activity.

Coders had identified that discharge summaries from paediatrics frequently contained diagnoses which were unclear or omitted relevant comorbidites. These provide a potential clinical risk for patients and typically result in underpayment for the hospital admission.

Aim

To reduce the rate of discharge summaries with unclear diagnoses or missed comorbidities by 50% in 3 months.

Method

• PDSA 1 - Education campaign for junior doctors to increase coding awareness
• PDSA 2 – Clinical coding induction package
• PDSA 3 - Initiation of a coding feedback loop between clinicians and coders

Measurement data was collected by the coding team during their normal practice and presented as rates of summaries with unclear diagnosis or missed comorbidities per 1000 discharge summaries on a run chart.

Results

Outcome:

Unclear diagnoses fell from an average of 36 per 1000 discharges to a low of 7 per 1000 discharges at 3 months (81% reduction). Similarly missed comorbidities fell from 112 per 1000 discharges to 19 per 1000 discharges (83% reduction).

Process measures:

Questionnaires completed by clinicians indicated an improvement in their understanding of clinical coding and increased awareness of their responsibilities to the coding process when writing discharge summaries.

Balancing measures:

Total time spent collecting data by the coding team was approximately 90 minutes per month.

Implications

This simple initiative of educating clinical staff about coding was successful in improving the quality of summaries from the department. It was difficult to quantify the overall financial gain. Challenges include the frequent turnover of staff and sustaining the improvement long term. There is potential for embedding solutions within I.T. systems for discharge summaries.