Area of good practice
Clinician flash cards
Background
One of the recommendations from the 2008/09 PbR assurance audit at Heart of England Foundation Trust was ‘to ensure that full case notes are used as the source documentation for clinical coding purposes across all specialties’.
High turnover of clinical coding staff compounded by high sickness levels at the time of the audit resulted in a lack of available resource to shift to coding high volume day case activity from notes. In addition often the Korner Medical Records (KMR) were not completed and some of the information codes required were not documented. Therefore the focus shifted to improving the quality of clinical documentation. The Trust felt that it was appropriate to code from a pro forma for day cases if the focus was on the quality of the clinical documentation.
The Clinical Coding team came up with the idea of a guide for clinicians on what information is really useful to clinical coders about the procedures they carry out. This would improve relationships with clinicians as well as ensuring that the clinical coding accurately reflected what had happened to the patient with the coder following coding rules and regulations.
The idea of a handy card that would fit into the clinicians top pocket of their shirts or sit alongside their name badge was suggested. The coding team would then be able to engage with the clinicians so that they could provide the very specific information coders require. Once the flash cards were developed they were distributed among the clinicians along with a briefing at the directorate meetings.
Objective
The key objective was to improve the quality of the documentation available to coders by educating clinicians on what specific information they required in order that the KMRs were complete and included a full record of the patient’s treatment/conditions.
These ‘flash cards’ are not an exhaustive list but just common things that are usually missed off the KMR. For more information clinicians are advised to look at the Royal College of Physicians’ top ten coding tips for clinicians.
Outline
The flash card concept has been developed for the following specialties specifically in relation to their day case activity, some directly linked to the Audit Commission’s clinical coding audit and some because the coding team were struggling to get the information they needed from the directorates.
- Ear, nose and throat
- Trauma and orthopaedics
- General surgery
- Pain management
- Paediatrics
- Gynaecology
The approach has been to improve the quality of record keeping and in some instances there is activity that can be coded well from pro formas once it is clear what information clinicians need to provide for coders to use.
The flash cards are produced on card and laminated and shared with clinicians in each of the above directorates.
Impact
To enable the Trust to identify whether or not these ‘flash cards’ were making a difference or not, the clinical coding auditor did a baseline audit and established that they were losing approximately £10 per day case activity due to inaccurate coding. The flash cards were launched to directorates in January and the Trust plan to reaudit in July 2010 to make an assessment as to whether these flash cards have had the desired impact.
The Coding department is also seeking verbal feedback from the general managers and clinicians themselves in these areas. The Clinical Coding Manager encourages all coders to make contact with their clinician if they have a query either by phone, email or face to face.
Source: Heart of England Foundation Trust