ABSTRACT
There is broad variability in provider documentation for asthma encounters within the pediatric emergency department. Inadequate provider documentation leads to discrepancies between the ideal current procedural terminology (CPT) code and the assigned CPT code based on the care provided. Multiple studies demonstrate improvement in medical provider documentation after implementing standardized documentation templates and educational programs. The primary aim of this project was to improve the concordance between the ideal CPT code and assigned CPT code from a baseline of 71% to 85% in 12 months. Methods: We introduced an asthma-specific note template in January 2018. We reviewed a random sample of 20 encounters per month to compare the ideal and assigned CPT codes in the baseline and intervention periods. The primary outcome measure was the percentage of encounters with agreement between ideal and assigned billing. The secondary outcome measure was the percentage of encounters with intravenous magnesium that were billed for critical care. The process measure was asthma note usage. Provider education and Plan-Do-Study-Act (PDSA) cycles continued throughout the intervention period. We used statistical process control to measure changes over time. Results: We reviewed 740 patient encounters over a 12-month baseline and 25-month intervention period. The average agreement between ideal and assigned CPT code increased from 71% to 89%, with 84% usage of the asthma note template. The percentage of critical care billing for intravenous magnesium increased from 15% to 55%. Conclusion: Implementation of an asthma-specific provider note template in the pediatric emergency department improved billing optimization and critical care billing.
ABSTRACT
BACKGROUND: Research demonstrates that timely recognition and treatment of sepsis can significantly improve pediatric patient outcomes, especially regarding time to intravenous fluid (IVF) and antibiotic administration. Further research suggests that underlying chronic disease in a septic pediatric patient puts them at higher risk for poor outcomes. OBJECTIVE: To compare treatment time for suspected sepsis and septic shock in pediatric patients with chronic disease versus those without chronic disease seen in the Pediatric Emergency Department (PED). METHODS: We reviewed patient data from a pediatric sepsis outcomes dataset collected at two tertiary care pediatric hospital sites from January 2017-December 2018. Patients were stratified into two groups: those with and without chronic disease, defined as any patient with at least one of eight chronic health conditions. INCLUSION CRITERIA: patients seen in the PED ultimately diagnosed with sepsis or septic shock, patient age 0 to 20 years and time zero for identification of sepsis in the PED. EXCLUSION CRITERIA: time zero unavailable, inability to determine time of first IVF or antibiotic administration or patient death within the PED. Primary analysis included comparison of time zero to first IVF and antibiotic administration between each group. RESULTS: 312 patients met inclusion criteria. 169 individuals had chronic disease and 143 did not. Median time to antibiotics in those with chronic disease was 41.9 min versus 43.0 min in patients without chronic disease (p = 0.181). Time to first IVF in those with chronic disease was 22.0 min versus 12.0 min in those without (p = 0.010). Those with an indwelling line/catheter (n = 40) received IVF slower than those without (n = 272), with no significant difference in time to antibiotic administration by indwelling catheter status (p = 0.063). There were no significant differences in the mode of identification of suspected sepsis or septic shock between those with versus without chronic disease (p = 0.27). CONCLUSIONS: Study findings suggest pediatric patients with chronic disease with suspected sepsis or septic shock in the PED have a slower time to IVF administration but equivocal use of sepsis recognition tools compared to patients without chronic disease.
