Increased length of inpatient stay and poor clinical coding: audit of patients with diabetes

Abstract

ObjectivesPeople with diabetes stay in hospital for longer than those without diabetes for similar conditions. Clinical coding is poor across all specialties. Inpatients with diabetes often have unrecognized foot problems. We wanted to look at the relationships between these factors.DesignA single day audit, looking at the prevalence of diabetes in all adult inpatients. Also looking at their feet to find out how many were high-risk or had existing problems.SettingA 998-bed university teaching hospital.ParticipantsAll adult inpatients.Main outcome measures(a) To see if patients with diabetes and foot problems were in hospital for longer than the national average length of stay compared with national data; (b) to see if there were people in hospital with acute foot problems who were not known to the specialist diabetic foot team; and (c) to assess the accuracy of clinical coding.ResultsWe identified 110 people with diabetes. However, discharge coding data for inpatients on that day showed 119 people with diabetes. Length of stay (LOS) was substantially higher for those with diabetes compared to those without (± SD) at 22.39 (22.26) days, vs. 11.68 (6.46) (P < 0.001). Finally, clinical coding was poor with some people who had been identified as having diabetes on the audit, who were not coded as such on discharge.ConclusionClinical coding – which is dependent on discharge summaries – poorly reflects diagnoses. Additionally, length of stay is significantly longer than previous estimates. The discrepancy between coding and diagnosis needs addressing by increasing the levels of awareness and education of coders and physicians. We suggest that our data be used by healthcare planners when deciding on future tariffs.

Prevalence and Distribution of Diabetes Mellitus in a Maximum Care Hospital: Urgent Need for HbA1c-Screening

“…The evaluation of the adjusted influence of diabetes on length of hospital stay show that patients with diabetes stay on average 1.1 days longer than patients with no diabetes or prediabetes. This significant impact of diabetes on the length of hospital stay is confirmed by other studies [11,20]. A previous study showed that the activation and subsequent intervention of a diabetes care team diminishes the average length of stay of patients with diabetes [20].…”

“…Unknown/undiagnosed diabetes is an additional risk factor for myocardial infarction and mortality, especially in ICU patients [9,10]. Furthermore, diabetic patients do not only have a higher risk of in-hospital mortality when suffering from an acute myocardial infarction [11], but also have a longer hospital stay than those without diabetes [11][12].…”

Primary care referral to multidisciplinary high risk foot services – too few, too late

“…The retrospective design relies heavily on both the ability of the treating team and the clinical coding team to accurately capture all relevant patient data and assign a correct primary diagnosis [ 26 ]. Errors may also occur in the ICD-10 conversion to the correct DRG [ 28 ]. A prospective study would allow greater accuracy in coding and classification.…”

An analysis of clinical activity, admission rates, length of hospital stay, and economic impact after a temporary loss of 50% of the non-operative podiatrists from a tertiary specialist foot clinic in the United Kingdom

“…Because the data presented in this study were contemporaneously collected by a small number of specialist staff who knew almost all of the patients personally, we were confident that we had a complete data set. However, admissions from other sources collected from clinical coding such as the Accident and Emergency department or Emergency Assessment Units were not recorded in this study because previous work done in our institution has shown inaccuracies in clinical coding and discharge data (10). …”