The Ohio State University Wexner Medical Center's Department of Otolaryngology – Head and Neck Surgery has recently enhanced its approach to inpatient charting, focusing on better documenting patients and their comorbidities prior to and during hospitalization. “We’ve revamped how we do inpatient charting so that when coders go through charts now, they have more information to help better stratify outcomes,” says Minka Schofield, MD.
ENT leaders launch new dashboard
In a comprehensive review of its performance metrics, the department identified opportunities to enhance coding accuracy, which is crucial for accurate patient documentation and outcomes.
Matthew Old, MD, and Minka Schofield, MD, MPH, spearheaded initiatives to review and improve medical coding practices. The initiative served two purposes: to improve cross-department coding in an environment where patients with comorbidities are sometimes seeing multiple specialists; and to review the department’s U.S. News & World Report ranking, as the application of patient coding underpins the department's ranking framework. While the primary goal of the audit was to remove subjectivity in coding and create more opportunities for coding review, it also sought to lead to better patient outcomes for multi-case individuals and improved data output for the university medical center.
Dr. Schofield, a clinical professor and director of the Division of General Otolaryngology with the Ohio State Wexner Medical Center, emphasized the need to study the methodology behind coding assignments. “We discovered that coding can be measured in various ways, depending on the program or organization," Dr. Schofield explains. This insight prompted a review that identified potential improvements in the coding data.
The investigation paid off, highlighting opportunities for improvements in coding, documentation, and in communication between clinical and coding teams. Drs. Old and Schofield collaborated with the university medical center’s coding department to implement a robust review system. This new process ensures immediate analysis of any mortality case attributed to ENT, which allows for timely corrections and adjustments in order to accurately reflect patient outcomes.
The department’s efforts culminated in a Coding Accuracy Dashboard, which enables real-time monitoring and review of coding cases. “Interestingly, because of this effort, the medical center decided to develop a more formal process for all departments to review their coding data and challenge any inaccurate assignments,” Dr. Schofield says. “The dashboard provides monthly data updates, which is much more current than the annual reporting we previously relied on.”
System-wide improvements
The success of this initiative has had a ripple effect across the university’s medical system. By fostering better integration between clinical teams and coders, the ENT department not only improved the accuracy of its data but also strengthened the processes underlying patient care documentation. “I am fortunate to lead a team of highly specialized and well-trained physicians who not only provide exceptional care for their patients but also embody true teamwork. At Ohio State, we are well-poised to treat the sickest patients, and our ability to treat the whole patient, beyond just ENT, is strengthened by precise coding. This leads to better patient outcomes and improved collaboration with other departments,” says James Rocco, MD, PhD, and chair of the Department of Otolaryngology – Head and Neck Surgery.
While the new dashboard primarily focuses on mortality metrics, it also includes additional data, such as length of stay. “We’re focused on delivering the highest quality care while improving processes to meet evolving standards, like discharge-to-home metrics,” says Dr. Old, clinical professor and director of the Division of Head and Neck Oncology.
Initiatives such as the Enhanced Recovery After Surgery, or ERAS, protocol have significantly reduced hospital stays, readmissions and narcotic use. With other advancements, including enhanced nutrition protocols for patients with head and neck cancer and the introduction of preoperative spirometry, the department is setting new benchmarks in patient outcomes.