Improving the quality of clinical coding and payments through student doctor–coder collaboration in a tertiary haematology department

BMJ Open Quality

article

Suha Abdulla¹  Natalie Simon¹  Kelvin Woodhams¹  Carla Hayman²  Mohamed Oumar¹  Lucy Rose Howroyd³  Gulshan Cindy Sethi¹ 

[1] School of Medical Education , King's College London;Clinical Coding Department , Guy's and Saint Thomas' NHS Foundation Trust;Guy's and Saint Thomas' NHS Foundation Trust

关键词: PDSA;    quality improvement;    medical education;    cost-effectiveness;    teamwork;   

DOI  :  10.1136/bmjoq-2019-000723

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Hospitals within the UK are paid for services provided by ‘Payment-by-Results’. In a system that rewards productivity, effective collaboration between coders and clinicians is crucial. However, clinical coding is frequently error prone and has been shown to impact negatively on departmental revenue. Our aim was to increase the median number of diagnostic codes per sickle cell inpatient admission at Guy’s Hospital by 3. Three interventions were implemented using the Plan, Do, Study, Act structure. This consisted of student doctors searching for diagnoses along with comorbidities that clinical coders had missed, distributing laminated cards with common clinical codes and implementing discharge pro formas. Through auditing, student doctors generated a total of £58 813 over 16 weeks. We observed an increase in the median number of codes by ≥2 additional codes. We improved coding accuracy where we identified errors in an average of 32.5% of admissions each month, improving the quality of patient documentation. We have demonstrated student doctor involvement in clinical coding as a potentially sustainable means of achieving accurate payment for services provided; increasing departmental revenue. We are the first to report the efficacy of student–coder collaboration in improving the accuracy of clinical coding.PDSAquality improvementmedical educationcost-effectivenessteamworkhttp://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND