1. The Health Roundtable Consultant Led ABF meetings Presenter: Sharon LINTON Sir Charles Gairdner Hospital Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1 4-4c_HRT1215-Session_LINTON_TCG_WA

2. The Health Roundtable KEY PROBLEM  There is currently a disconnect between Clinicians and Clinical Coding  This results in  Missed revenue opportunities  No education or feedback mechanism for junior staff to alert them on what is vital / superfluous information for Clinical Coders  No feedback to Consultant staff regarding utility of Junior Doctors entries from a coding/revenue perspective

3. The Health Roundtable AIM OF THIS INNOVATION  To identify, and implement a process that enables Clinical Coders to more accurately capture information regarding a patients episode

4. The Health Roundtable BASELINE DATA  The size of the problem was unknown prior to undertaking this study  There was however a perception amongst Coders, Consultant Staff and Hospital Executive that there was a significant amount of under-coding given issues with current process

5. The Health Roundtable KEY CHANGES IMPLEMENTED  Multidisciplinary Meeting Trial  October – December 2011  1x Medical and 1x Surgical Team involved in trial  Consultants, Junior Staff and Clinical Coder present for 45 minute meeting  Process 1. Notes gathered for all patients with a LOS of greater than 7 days, who were discharged in the past week 2. Simultaneous projection of discharge summary and coding software 3. Revision of all cases for coding together with the discharge letter. 4. One set of notes was selected for further analysis of Junior Medical Staff entries.

6. The Health Roundtable

7. OUTCOMES SO FAR  Immediate advantages evident  Medical Teams  100% of Discharge Letters reviewed by Consultants  Education direct to Consultants and Junior Staff regarding ‘key terms’ that need to be included to ensure episode can be captured – ie ‘acute exacerbation of COPD’  Quality of documentation for Clinical Care increased as a result of weekly consultant review  Coding Teams  Delights of clinical terms, humour and slangs of a surgical team  Education of junior and senior staff to coding requirements in the notes and key words for DRG changes in their specialty  100% coding done within a week  Accurate input of medical team as cases very recent or ongoing

8. The Health Roundtable OUTCOMES SO FAR  Financial Outcomes  30% of cases reviewed in the presence of Consultant, Junior Staff and Clinical Coders had a DRG change  The financial outcomes of this change, per case was  Medical - $5,000  Surgical - $10,000  If extrapolated just across General Surgery (2000 annual separations), additional annual revenue = $6m p/a  If extrapolated across all hospital units, a conservative estimate at additional revenue = $50m p/a

9. The Health Roundtable LESSONS LEARNT  Consultant staff need to see the clinical benefit in facilitating these meetings  Dual projection facilitates the simultaneous viewing of Discharge Summaries and Coding software  This meeting format demonstrated significant outcomes such as timeliness and accuracy of letters, revision of late patients results, confirmation of all clinical follow up plans, accuracy and readability of junior staff entries

10. The Health Roundtable Contacts Professor Luc Delriviere Head of Service – WA Liver and Kidney Transplant Service Sir Charles Gairdner Hospital Luc.delriviere@health.wa.gov.au Sharon Linton Coordinator, Clinical Coding Sir Charles Gairdner Hospital Sharon.Linton@health.wa.gov.au