The New Zealand medical journal · 2018
Improving quality of clinical coding of post-partum haemorrhage: the process and its effects on reported incidence rates in a New Zealand hospital maternity service.
СтатьяНазвание и аннотация: Перевод в очереди
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Galgali Geetha, Fong Kim, Bissell Karen, Armstrong Delwyn, Humphrey Gayl
Аннотация
AIM: The Waitemata District Health Board (DHB) aimed to investigate and improve the accuracy of its reporting of post-partum haemorrhage (PPH), to understand its true incidence.
METHOD: The quality improvement project included multidisciplinary collaboration between maternity clinicians and clinical coders, substantive redesign of the Waitemata DHB's birth documentation form, systematic auditing and follow-up of clinical documentation by a dedicated quality midwife, linking of maternity clinicians to a key designated senior coder and ongoing PPH incidence monitoring and staff education.
RESULTS: The coded rate of PPH has risen dramatically and is now in line with expected Australasian incidence levels. A corresponding increase in the value of cost-weighted discharges (estimated at $544,000 for the 2015/16 financial year) was realised as a result of the more accurate reported incidence.
CONCLUSION: This case illustrates the value of coding to a clinical service and the importance of clinical leadership and engagement in achieving successful and sustainable service redesign initiatives. It provides an example of how to evaluate and update coding and a process for changing the way clinicians and coders work that could benefit other services in Waitemata DHB as well as in other New Zealand district health boards.
METHOD: The quality improvement project included multidisciplinary collaboration between maternity clinicians and clinical coders, substantive redesign of the Waitemata DHB's birth documentation form, systematic auditing and follow-up of clinical documentation by a dedicated quality midwife, linking of maternity clinicians to a key designated senior coder and ongoing PPH incidence monitoring and staff education.
RESULTS: The coded rate of PPH has risen dramatically and is now in line with expected Australasian incidence levels. A corresponding increase in the value of cost-weighted discharges (estimated at $544,000 for the 2015/16 financial year) was realised as a result of the more accurate reported incidence.
CONCLUSION: This case illustrates the value of coding to a clinical service and the importance of clinical leadership and engagement in achieving successful and sustainable service redesign initiatives. It provides an example of how to evaluate and update coding and a process for changing the way clinicians and coders work that could benefit other services in Waitemata DHB as well as in other New Zealand district health boards.