Download - AKI mortality -the coding of these patients Countess of Chester Hospital NHS Foundation Trust
AKI mortality -the coding of these patients
Countess of Chester Hospital NHS Foundation Trust
Team Details
Dr Tim Webster, Consultant Physician
Sarah Balogh, Clinical Information Analyst
Michael Jones, Coding Team Leader
Michael Spry, Clinical Improvement & Assurance Manager
Mr Ian Harvey, Medical Director
Email: [email protected]
What was your original project Aim and has this changed?
AIM: To improve the accuracy of mortality data for AKI at the Countess.
To remove the “it’s the data not us” argument from mortality conversations
And fix the “FCE”
Driver Diagram
Measures and Data
• Identified as an outlier for renal failure
deaths
• 46 deaths in 12 months
46 case notes
Reviewed from admission to
death
Checked against audit
standards
Summary of resultsStandard Aim Compliance
EWSs score 100% 78%
Urine dip requested 100% 58%
MSSU requested 100% 42%
Fluid balance requested 100% 58%
Nephrotoxics stopped 100% 74%
Anti-hypertensives stopped 100% 78%
Catheter decision documented 100% 36%
Urgent Renal USS 100% 31%
Daily U&E requested 100% 49%
Senior review 100% 87%
Appropriate referral 100% 69%
AKI staged 100% 0%
Time from U&E taken to patient seen
Was AKI diagnosed on first documentation
Coding
Why is this?• 1 = no AKI• 9 = resolved to normal• 6 = ‘end of life’
Represents 35% of the cases
In relation to death certificates?‘End of life’:
Resolved:
Coding: conclusionsNot appearing on death certificate• 11 of 13 appropriately so
16 of 46 did not die from AKI
The FCE…..• A Finished Consultant Episode is the time a
patient spends in the continuous care of one consultant using hospital site or care home bed(s) of one health care provider or, in the case of shared care, in the care of two or more consultants. Where care is provided by two or more consultants within the same episode, one consultant will take overriding responsibility for the patient and only one consultant episode is recorded.
What we’ve tried• Casenote review of all TW patients coded
with AKI in 3 months= 0
• Casenote review of all AKI deaths coded over 3 months. – Only 3 cases identified. All appropriate.
• Endless meetings to try and alter the way FCEs are identified through meditech- unable to unpick this problem
• Pilot of block coding all FCEs together on MAU to ensure no part of MAU spell is missed - no change in outcome achieved as FCE2 still remains on MAU.
• Need FCE 2 on base ward following MAU stay to achieve accurate coding – how this can be achieved remains an issue
Other Related Work• Clinical improvements in AKI ongoing
through separate AQ/CQUIN working party
• Live coding pilot within stroke department is showing significant benefits - ?could translate into other areas
Key Achievements & Lessons Learnt• Proud of persevering with ‘dry’ topic, complex – better understanding of coding issues and
improved communication with coding department• Live coding on one COE ward as a pilot – daily coding to go through casenotes to ensure agree
with coding and have a co-morbidity checklist. Re-enforced use of diagnosis at PTWR, and coders now attending specialty meetings to re-enforce coding.
• What would you do differently – unpicking of clinical and administrative complexity of mortality – difficult to focus on both
• IT issues have been very frustrating – creating our own process constraints effecting our performance
• Live coding due to roll out – reduced FCEs, improved coding – clearer indication of focus• Team regularly meeting to keep momentum• More focused brief – avoid duplication of clinical aspects e.g. multiple projects looking at AKI
What should AQuA do differently
• Collaborative working could have been very useful
• Timescale seems to have lost some momentum• Initial focus on choosing a project could have
been helpful – some difference of opinion between team and AQuA around the value of ‘coding/FCEs’ as a project- this could have been raised earlier