Reducing the Reported Mortality Index Within a Neurocritical Care Unit Through Documentation and Coding Accuracy

Kessler, Brice A.; Catalino, Michael P; Jordan, J. Dedrick

doi:10.1016/j.wneu.2019.10.022

Cited by 12 publications

(7 citation statements)

References 5 publications

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“…[5] Furthermore, studies have had success by utilizing educational presentations, pocket reference cards, precoder, and documentation teams. [8,14,16] While these interventions show a proven method of improving quality metrics, there are several improvements needed such as convenience, opportunity for real-time data updating, and increased time efficiency. A recent study by Kessler et al showed success by utilizing a spreadsheet tool which answers some of these concerns.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study by Kessler et al showed success by utilizing a spreadsheet tool which answers some of these concerns. [8] In addition, the use of technology and mobile phones has been proven to be impactful in enhancing patient care, provider education, and data delivery. [4] However, mobile phones are a powerful and unexplored modality for documentation improvement in neurosurgery, a department with great potential due to high acuity and busy censuses.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple barriers exist between providers and coders including the value placed on documentation as well as the language used between parties. [ 8 ] Providers may not see the value in accurate and detailed documentation as they may not be familiar with the coding process. They may be unaware of the downstream effect; their documentation has on reimbursement as well as their own and their hospital’s quality rankings.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 ] The previous studies in neurosurgical departments have had great success in improving quality metrics by addressing clinical documentation. [ 8 , 11 ] However, quality improvement in large institutions has no onesize-fits-all solution due to the different personalities and approaches among teams, service lines, and departments. Generic educational sessions and printed material only capture limited attention and motivation from providers and have been shown to poorly influence provider practices and patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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MedCDI: A technology-based documentation and quality improvement initiative in neurosurgery

Porwal

Feller

Kumar

et al. 2022

Surgical Neurology International

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Background: Clinical documentation of patient care alters coding accuracy of Medicare Severity Diagnosis-Related Groups (MS-DRGs), expected mortality, and expected length of stay (LOS) which impact quality metrics. We aimed to determine if neurosurgical quality metrics could be improved by facilitating accurate documentation and subsequently developed a mobile application and educational video to target areas of opportunity. Methods: Vizient software was used to analyze MS-DRGs and expected LOS for sample of patients requiring surgery for spinal pathology, brain tumors, and subarachnoid hemorrhage (SAH) between January 2019 and August 2021. Chart reviews were conducted to discover variables missed by documenting provider and/or coder. Results: Review of 114 spinal surgeries, 20 brain tumors, and 53 SAH patients revealed at least one additional variable impacting LOS in 43% of spine, 75% of brain tumor, and 92% of SAH patients, with an average of 1 (1.25), 2 (1.75), and 3 (2.89) new variables, respectively. Recalculated expected LOS increased by an average of 0.86 days for spine, 3.08 for brain tumor, and 6.46 for SAH cases. Conclusion: Efforts to accurately document patient care can improve quality metrics such as expected LOS, mortality, and cost estimates. We determined several missing variables which impact quality metrics, showing opportunity exists in neurosurgical documentation improvement. Subsequently, we developed an educational video and mobile-supported application to specifically target these variables. To the best of our knowledge, this represents the first initiative to utilize the proven powers of mobile phones in health care toward the novel application of specifically improving neurosurgical quality metrics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MedCDI: A technology-based documentation and quality improvement initiative in neurosurgery

Porwal

Feller

Kumar

et al. 2022

Surgical Neurology International

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“…QI strategies for other NCCU processes, such as the transition to comfort care [31], clinical documentation strategies to optimize risk-adjusted outcomes [63], palliative care consultation [63,64], and DVT chemoprophylaxis [65], have also been published.…”

Section: Processesmentioning

confidence: 99%

Quality Improvement in Neurocritical Care: a Review of the Current Landscape and Best Practices

Karanjia

Dugyala

Olm-Shipman

et al. 2022

Curr Treat Options Neurol

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Purpose of Review The field of neurocritical care (NCC) has grown such that there is now a substantial body of literature on quality improvement specific to NCC. This review will discuss the development of this literature over time and highlight current best practices with practical tips for providers. Recent Findings There is tremendous variability in patient care models for NCC patients, despite evidence showing that certain structural elements are associated with better outcomes. There now also exist evidence-based recommendations for neurocritical care unit (NCCU) structure and processes, as well as NCC-specific performance measure (PM) sets; however, awareness of these is variable among care providers. The evidence-based literature on NCC structure, staffing, training, standardized order sets and bundles, transitions of care including handoff, prevention of bounce backs, bed flow optimization, and inter-hospital transfers is growing and offers many examples of successful performance improvement initiatives in NCCUs. Summary NCC providers care for patients with life-threatening conditions like intracerebral and subarachnoid hemorrhages, ischemic stroke, and traumatic brain injury, which are associated with high morbidity, complexity of treatment, and cost. Quality improvement initiatives have been successful in improving many aspects of NCC patient care, and NCC providers should continue to update and standardize their practices with consideration of this data. More research is needed to continue to identify high-risk and high-cost NCCU structures and processes and strategies to optimize them, validate current NCC PMs, and encourage clinical adoption of those that prove to be associated with improved outcomes.

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Protocol for Analysis of Root Causes of Problems Affecting the Quality of the Diagnosis Related Group-Based Hospital Data: A Rapid Review and Delphi Process

Oliveira

Santos

et al. 2020

Trends and Innovations in Information Systems and Technologies

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Reducing the Reported Mortality Index Within a Neurocritical Care Unit Through Documentation and Coding Accuracy

Cited by 12 publications

References 5 publications

MedCDI: A technology-based documentation and quality improvement initiative in neurosurgery

MedCDI: A technology-based documentation and quality improvement initiative in neurosurgery

Quality Improvement in Neurocritical Care: a Review of the Current Landscape and Best Practices

Protocol for Analysis of Root Causes of Problems Affecting the Quality of the Diagnosis Related Group-Based Hospital Data: A Rapid Review and Delphi Process

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