Background
CHKS has been working with a large acute trust in the Midlands which was created from the merger of two separate trusts operating on different sites. The trust now provides many specialist services and a broad range of emergency services, including Accident & Emergency as well as comprehensive community services.
The scale of the challenge
Around 150,000 consultant episodes are coded at the trust each year and since merging, the two hospitals continued with their own individual clinical coding working practices. Following the introduction of a unified management structure, the trust recognised the need to standardise and integrate the coding service. It commissioned CHKS to carry out a service review of coding practice to get a better understanding of how clinical coding is undertaken operationally and managerially across the two sites and to ensure the consistency of working practices, training, staffing and coding procedures across the trust.
Meeting the challenge
CHKS found that different working practices had resulted in different levels of productivity between sites with an average of 8,761 Consultants Episodes (CEs) per coder per annum at one site and 7,185 at the other. CHKS felt both sites should be delivering at least 8,400 coded CEs per coder per annum and recommended the appointment of a Band 7 Clinical Coding Services Manager supported by two Band 5 Clinical Coding Officer Team Leaders. The Band 7 Services Manager would be responsible for encouraging greater clinical engagement, improving the training programmes leading to greater depth of coding and ensuring full integration of the clinical coding team.
CHKS also recommended that the trust ensure encoder software is used across both sites which would help to reduce workload and overtime costs. The introduction of internal audit and annual external audit was recommended to improve data quality and eliminate the need for coders to check each other’s work except in the case of trainees.
The benefits of working with CHKS
The recommendations were estimated as being effectively cost neutral given the potential for raised productivity. The trust is now hoping to make financial savings as well as improve the quality of service and achieve some uniformity of working practices across the two sites.
