It comes as little surprise that everything the coding department at the University College London Hospitals NHS Foundation Trust does is geared to one thing – accuracy. As winner of the data quality award (England), the trust understands the important connection between quality data, quality care and the financial benefits of accurate data.
The coding team has been nurtured and developed with that in mind. Stringent processes are in place to ensure that data is accurate and up to date and no data are missing. Pivotal to its success is the admin team. One of the roles of the team is to chase up any missing case notes or summaries. The process is clear - if information is missing, the team notifies the general manager for the division and gives them 48 hours to provide it before flagging up the situation to the team’s manager and then the operational director.
Head of coding Greg Stephenson says: “It has to be a robust process so the coders aren’t left chasing their tails and can carry on with other work. If you don’t have a structured approach, things get missed or start to slip. That has an accumulative affect when it comes to data quality. Things build up until you get a mortality event or a drop in income.”
The coding team ensures that everyone across the trust is aware of the importance of accurate data and that junior doctors understand the necessity and value of accurate coding from the very beginning. They attend all junior doctor induction sessions and have also devised a clinical coding e-learning module, which all junior doctors have to complete as part of their training.
Greg says: “It helps them realise early on the importance of good coding and what the coding team needs from them, for instance using words such as likely or probable rather than a question mark. We also work with the governance teams. We show them what the ideal discharge summary looks like and show them the bad ones for comparison.”
The coding team comprises specialist teams that are split into three areas: surgery and cancer, medicine and specialist hospitals. Each coder is given their own portfolio of work to manage. Coders have to keep a manual record of what they have coded and are given ten minutes for day cases and 15 minutes for inpatient cases. To ensure productivity never comes at the cost of quality, the process can be adjusted according to complexity.
To ensure continual improvement the department also has a bi-monthly audit with its own auditor. A formal report is compiled and each coder will have the opportunity to go through it and discuss with their team leader about how to improve techniques and practices. Trend analysis helps to keep track of how people are progressing.
The trust invests heavily in training and developing its coding staff. Monthly specialist workshops are held and coders are given the opportunity build up their knowledge base and skill mix. The aim is always to promote from within so all managers have been coders. Everyone has the same exposure and opportunities on training courses, rather than one person being sent on training and then feeding the information back.
The team also maintains good relations with clinical directors either with regular face to face meetings, or where appropriate, emails. The current focus is getting the trust ready for HRG4+. For every change that happens a specific workshop is set up so that everyone is conversant with the changes and impact.
