View June's Board Pack - Royal Bournemouth Hospital

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Appendix 3 – Specialty A - General Medicine61 At The Royal Bournemouth and Christchurch Hospitals NHSFoundation Trust the follow up area covered was General Medicine whichwas audited in 2009/10. This audit was at a specialty level, covering allHRGs / chapters. A sample of 100 cases was provided for audit and nonewere found to be unsafe to audit as per NHS CFH standards.Table 7: Specialty A General Medicine area: coding errorsPrimarydiagnosisSecondarydiagnosisPrimaryprocedureSecondaryprocedureTotalfromepisodesauditedIncorrectCoderErrorNoncodererrorTotalincorrect% incorrect2010/11 2009/10100 9 3 12 12.0 46.0296 15 12 27 9.1 41.634 2 2 4 11.8 13.39 0 0 0 0.0 7.9Overall 439 26 17 43 9.8 36.9Table 8: Specialty A area: HRG errorsEpisodesSpellsTotal 100 52Total changing HRG 7 5% changing HRG 7.0 9.6Analysis of coding errors62 The audit identified 43 (9.8 per cent) errors in procedure and diagnosescoding, leading to seven HRG changes. The impact of the seven HRGchanges was that the Trust was undercharging its commissioners by £47 onthe sample tested.Audit Commission Payment by results data assurance framework 21
63 The following areas for improvement have been identified:■ reinforcing the importance of recording the mandatory co-morbiditiesfrom the March 2010 Coding Clinic, as omission of secondarydiagnoses was an issue from both the coder and clinical perspective.This accounted for 53.5 per cent of the errors in this area; and■ providing training to the coders to cover the definition of the primarydiagnosis. There were nine coder errors at primary diagnosis level (20.9per cent).64 There were 17 non-coder errors due to the source document not havingall of the information for the coder at the time/point of coding, this affectedthree primary and 12 secondary diagnoses plus two primary procedures.65 The coder errors were in the following areas:■ incorrect coding at the required 3-, 4- and 5- character level affectingseven primary and four secondary diagnoses and two primaryprocedures; and■ omission of diagnosis and procedures – affecting two primary and 11secondary diagnoses.66 There are 10 instances when information not relevant to the episode ofcare has been coded. NHS CFH does not treat this as an error and werethey to have been included they would have accounted for none of the HRGchanges. The Trust should seek to code only relevant information.Follow up of audit in this area from 2009/1067 General Medicine was audited in 2009/10 and was selected as an areafor follow up. It is important to note that different OPCS versions may havebeen in use at the time of the audits. This can have an impact on the overallHRG error rate.Table 9: Follow up of HRG changesEpisodes2010/11 2009/10 ChangeTotal 100 100 -Total changingHRG 7 35 -28% changingHRG 7.0% 35.0% -28.0%68 The HRG and coding error rate have improved considerably since2009/10. This result could be better if training was provided coveringprimary diagnosis definition and the March 2010 Coding Clinic regarding thecoding of relevant mandatory co-morbidities.Audit Commission Payment by results data assurance framework 22
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THE ROYAL BOURNEMOUTH AND CHRISTCHU
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