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Implementation of a collaborative multisite ASP supported by a centrally deployed CDSS was associated with changes in targeted antimicrobial use, decreased antimicrobial costs, decreased HCA-CDI rates, and no observable increase in LOS or mortality. Ongoing targeted interventions are suggested to promote sustainability.

The aim was to investigate the accuracy of clinical information coding and the financial consequence for trauma patients at a tertiary trauma centre using the resources of trauma nursing case managers. Clinical data for admitted trauma patients in August and September 2000 were compared with data routinely obtained by trauma case managers on their daily rounds. We audited patient injuries, in-hospital complications, investigations, and procedures. Clinical information records requiring alteration were returned to the clinical information manager with additional information and re-entered into the clinical information database. 100 trauma patient records (15% of admissions for 2000) were audited. 28% of recoded records had to have their diagnosis related group (DRG) changed, which resulted in the identification of additional funding of over $39,000. We conclude that the implementation of episode funding for acute episodes, such as the complex trauma patient, is placing increased importance on accuracy of coding. The validity of coding is dependent on legible, comprehensive and complete documentation and is improved dramatically by using nursing case manager patient progress summaries.

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Objective. This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix.Methods. Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008-09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined.Results. There were 16 693 patients at a total cost of AU$178.7 million. The total costs incurred by trauma centres were $14.7 million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500 000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P < 0.001).Conclusions. AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed.What is known about this topic? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. What does this paper add? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated. What are the implications for practitioners? Further work should be conducted between trauma services, clinical coding and finance departments to improve the accuracy of clinical coding, review funding models and ensure that AR-DRG allocation is commensurate with the expense of trauma treatment.