A Continuous Quality Improvement Approach to IL‐372 Documentation Compliance in an Academic Emergency Department, and Its Impact on Dictation Costs, Billing Practices, and Average Patient Length of Stay

Abstract

Abstract. Objective: To determine whether continuous quality improvement (CQI) methodology could improve and maintain IL-372 documentation compliance in an academic emergency department (ED). The impact on transcription costs, billing practices, and average patient length of stay was also analyzed. Methods: Baseline IL-372 compliance data were collected and shared with staff during a multidisciplinary educational session. Faculty dictation became mandatory. Pocket-sized dictation templates were provided. A Documentation Improvement Committee monitored outcomes. Each month of the study period, a compliance officer reviewed approximately 100 records. The following indicators were monitored: IL-372 compliance rates, dictation rates, transcription costs, down-coding rates, percentage of billable records, and average patient length of stay. Individualized results were provided to faculty. Results: During the ten-month study period, compliance rates increased from 60% to 100% (p-trend < 0.001), while dictation rates increased from 69% to 100% (p < 0.001). Rates of down-coding adjustments improved from 54% to 2% (p-trend < 0.001). The percentage of billable records increased from 65% to 100% (p-trend < 0.001). Transcription costs increased a modest 16%. The average patient length of stay remained unchanged. Conclusion: The application of CQI methodology, combined with the availability of dictation, resulted in sustained improvement in IL-372 compliance. This was associated with a parallel increase in dictation rates, although concurrent transcription costs increased only modestly. The percentage of billable records increased, while the number of charts requiring down-coding decreased, both beneficial outcomes. Average length of stay was not adversely impacted by this added documentation requirement.

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

“…The most recent work employing QI is cited in Lovett et al [80] who reported an intervention at a multi-campus academic health system where immediate improvements were enhanced in relation to LOS. Other works employing QI can be seen in Brent et al [76], Fernandes and Christenson [77], Fernandes et al [78], Higgins III and Becker [79], Preyde et al [81], and Rehmani and Amatullah [82]. The application of six sigma [93], PDSA cycle [84,85], and ED dashboard/reporting application [98] were also detected in the literature as part of the multiple quality-based methods that have been applied for solving the excessive LOS problem in EDs.…”

Optimizing Advanced Practitioner Charge Capture in High-Acuity Surgical Intensive Care Units

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