title: A continuous quality improvement approach to IL-372 documentation compliance in an academic emergency department, and its impact on dictation costs, billing practices, and average patient length of stay.
abstract: OBJECTIVE
  To determine whether continuous quality improvement (CQI) methodology could improve and maintain IL-372 documentation compliance in an academic emergency department (ED). The impact on transcription costs, billing practices, and average patient length of stay was also analyzed.
  
  
  METHODS
  Baseline IL-372 compliance data were collected and shared with staff during a multidisciplinary educational session. Faculty dictation became mandatory. Pocket-sized dictation templates were provided. A Documentation Improvement Committee monitored outcomes. Each month of the study period, a compliance officer reviewed approximately 100 records. The following indicators were monitored: IL-372 compliance rates, dictation rates, transcription costs, down-coding rates, percentage of billable records, and average patient length of stay. Individualized results were provided to faculty.
  
  
  RESULTS
  During the ten-month study period, compliance rates increased from 60% to 100% (p-trend < 0.001), while dictation rates increased from 69% to 100% (p < 0.001). Rates of down-coding adjustments improved from 54% to 2% (p-trend < 0.001). The percentage of billable records increased from 65% to 100% (p-trend < 0.001). Transcription costs increased a modest 16%. The average patient length of stay remained unchanged.
  
  
  CONCLUSIONS
  The application of CQI methodology, combined with the availability of dictation, resulted in sustained improvement in IL-372 compliance. This was associated with a parallel increase in dictation rates, although concurrent transcription costs increased only modestly. The percentage of billable records increased, while the number of charts requiring down-coding decreased, both beneficial outcomes. Average length of stay was not adversely impacted by this added documentation requirement.
authors.affiliation: Department of Emergency Medicine, Maine Medical Center, Portland 04102, USA. higgig@mail.mmc.org
authors.forename: G L
authors.initials: GL
authors.lastname: Higgins
authors.forename: M H
authors.initials: MH
authors.lastname: Becker
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration* / Q000592:standards; D004282:Documentation; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005568:Forms and Records Control; D006801:Humans; D007902:Length of Stay; D008281:Maine; D008499:Medical Records / Q000592:standards*; D006278:Medicare; D011446:Prospective Studies; D017749:Total Quality Management; D014481:United States