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.

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.