We developed the Michigan Body Map (MBM) as a self-report measure to assess body areas where chronic pain is experienced and to specifically quantify the degree of widespread body pain when assessing for centralized pain features (e.g., fibromyalgia-like presentation). A total of 402 patients completed the measure in five distinct studies to support the validation of the original and a revised version of the MBM. Administration is rapid 39–44 sec and errors for the original MBM were detected in only 7.2% of the possible body areas. Most errors underestimated the number of painful areas or represented confusion in determining the right versus left side. The MBM was preferred (p=0.013) and felt to better depict pain location (p=0.001) when compared to the Widespread Pain Index checklist of the 2011 Fibromyalgia Survey Criteria, but participants did not express any preference between the MBM and Brief Pain Inventory body map. Based on the data from the first three studies, a revised version of the MBM was created including a front and back body image and improved guidance on right-sidedness versus left. The revised MBM was preferred when compared to the original and more accurate in depicting painful body areas (p=0.004). Furthermore, the revised MBM showed convergent and discriminant validity with other self-report measures of pain, mood and function. In conclusion, the MBM demonstrated utility, reliability and construct validity. This new measure can be used to accurately assess for the distribution or widespreadedness of bodily pain as an element of the fibromyalgia survey score.

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Objective To assess the impact of implementation of a "1-step" documentation query system on comorbidity capture and quality outcomes within the Department of Otolaryngology-Head and Neck Surgery. Methods Implementation of the 1-step documentation query system was instituted for all otolaryngology-head and neck surgery faculty at a single institution. Individual query responses and impact metrics were analyzed. Departmental case-mix index (CMI), risk of mortality (ROM), and severity of illness (SOI) were collated over a 14-month implementation period and compared to a 12-month preimplementation period. Results A total of 226 documentation queries occurred during the program pilot period, with an 86.7% response rate. Of queries with a response, 91.0% resulted in a significant impact for the hospitalization diagnoses-related group, ROM, or SOI. Departmental CMI increased from 2.73 to 2.91 over the implementation period, and observed/expected mortality ratio decreased from 0.50 to 0.42 pre- to postimplementation. Discussion With increasing emphasis on quality metrics outcomes within the United States health care system, there is a need for institutions to accurately capture the complexity and acuity of the patients they care for. There was a positive change in quality outcomes metrics, including ROM, SOI, and CMI over the first year of deployment of the 1-step documentation query process. Implications for Practice Clinical severity metrics are becoming increasingly important to otolaryngologists, as insurers move to severity-adjusted profiles. The 1-step documentation query process provides a reproducible and effective way for clinical documentation specialists and physicians to collaborate on improving departmental clinical severity metrics.

Performance improvement is a mainstay of operations management and maintenance of certification. In this study at a University Hospital inpatient rehabilitation unit, Lean management techniques were used to manage throughput of patients into and out of the inpatient rehabilitation unit. At the start of this process, the average admission time to the rehabilitation unit was 5:00 p.m., with a median time of 3:30 p.m., and no patients received therapy on the day of admission. Within 8 mos, the mean admission time was 1:22 p.m., 50% of the patients were on the rehabilitation unit by 1:00 p.m., and more than 70% of all patients received therapy on the day of admission. Negative variance from this performance was evaluated, the identification of inefficient discharges holding up admissions as a problem was identified, and a Lean workshop was initiated. Once this problem was tackled, the prime objective of 70% of patients receiving therapy on the date of admission was consistently met. Lean management tools are effective in improving throughput on an inpatient rehabilitation unit.