The impact of an otolaryngology inpatient consult documentation improvement program.

Objective: In an era of limited medical training funds and challenges for teaching centers to maintain their academic mission, the importance of accurate documentation to ensure commensurate coding and billing for services is critical. We sought to develop a practical program that would teach residents documentation skills with the goal of more accurately capturing the work being done in a tertiary care academic medical center. Methods: A case-control study was performed. Otolaryngology inpatient and Emergency Department consultation notes at a single tertiary medical center were reviewed and knowledge gaps and shortcomings in documentation identified. Three short educational sessions were provided on documentation skills. During the same timeframe, templates in the electronic medical record were standardized to help maintain thoroughness of documentation within the consultation note. Results: A total of 1476 consultations performed by the Otolaryngology department during a 9-month period in FY17/18 (preintervention) were compared to a total of 1622 consultations performed during the same 9-month period in FY19/20 (postintervention). The percent of billable consultations increased from 42.4% to 50.9% (p < .001). Similarly, the percentage of consultations coding at a higher level of complexity rose from 51.6% to 59.5% (p = .002). This improvement led to an increase in consultation charges of more than $130,000. Conclusion: This study demonstrates that a simple documentation and coding curriculum and workflow interventions can lead to more thorough and improved consult documentation as evidenced by a significant increase in the percentage and complexity of billable Otolaryngology consultations at a tertiary academic center. Level of Evidence: 4.

Pregnancy and Fertility Trends Among Female Otolaryngologists.

OBJECTIVE: This study sought to determine childbearing patterns and decision making among female otolaryngologists. STUDY DESIGN: Anonymous survey. SETTING: An anonymous survey was sent in 2020 to female otolaryngologists identified through their membership with the American Academy of Otolaryngology-Head and Neck Surgery. METHODS: Data were analyzed concerning individual fertility and childbearing history, reflections regarding decision making, perceptions of workplace support, and estimations of objective childbearing potential. RESULTS: There were 398 responses. The mean age at first pregnancy was 32.3 years. Almost one-third of respondents who attempted to conceive (30.4%) were diagnosed with infertility. Of those who had their first pregnancy during training, 55% reported having substantial workplace support, as opposed to 70% of those whose first pregnancies followed completion of training (P = .01). When asked what they would do differently in retrospect, most women with infertility (65.0%) would have attempted conception earlier; 41 (41.0%) would have used cryopreservation to extend fertility; and 14 (14.0%) would have gone into a different specialty. CONCLUSION: Female otolaryngologist respondents have children later in life than the general population, and a substantial proportion face infertility or have regrets about family planning decisions and career decision making. Increased awareness, further investigation, and targeted programs are needed to support the growing number of female otolaryngologists who desire both a career and a family.

Comparison of Oral Loading Dose to Intravenous Acetaminophen in Children for Analgesia After Tonsillectomy and Adenoidectomy: A Randomized Clinical Trial.

BACKGROUND: Acetaminophen is a frequently used adjunct analgesic in pediatric patients undergoing tonsillectomy and adenoidectomy. We compared opioid administration following preoperative intravenous (IV) or oral acetaminophen in addition to a standard multimodal regimen to test the hypothesis that 1 loading dose approach would provide superior opioid sparing effects among pediatric surgical patients undergoing tonsillectomy and adenoidectomy. METHODS: This single-center, double-blind, double-dummy prospective randomized study was conducted in patients ages 3 to 15 years undergoing tonsillectomy and adenoidectomy with or without myringotomy and tube placement between September 2017 and July 2019. Subjects received 1 dose of either oral acetaminophen 30 mg/kg with IV placebo (oral group) or IV acetaminophen 15 mg/kg with oral placebo (IV group). Acetaminophen plasma levels were measured at 2 timepoints to evaluate safety and determine plasma levels attained by each dosing regimen. Intraoperative opioid administration and postoperative analgesia were standardized. Standardized postoperative multimodal analgesia included opioid if needed to control pain assessed by standardized validated pediatric pain scales. The primary outcome measure was total opioid administration in the first 24 hours after surgery. Continuous data were not normally distributed and were analyzed using the Wilcoxon rank sum test and the Hodges-Lehman estimator of the median difference. Clinical significance was defined as a 100 µg/kg IV morphine equivalents per day difference. RESULTS: Sixty-six subjects were randomized into and completed the study (29 women, 37 men; age 5.9 ± 3.0 years; percentile weight for age 49.5 ± 30.2; no differences between groups). There was no opioid dose difference between oral (median 147.6; interquartile range [IQR], 119.6-193.0 µg/kg) and IV groups (median 125.4; IQR, 102.8-150.9 µg/kg; median difference 21.3; 95% confidence interval [CI] -2.5 to 44.2 µg/kg IV morphine equivalents; P = .13). No acetaminophen levels exceeded the predefined safety threshold (40 mg/L). No difference was found in the percentage of patients with severe pain: 50.0% oral group, 47.2% IV group; relative risk of severe pain in IV 0.94; 95% CI, 0.57-1.6; P = .82. Postoperative plasma acetaminophen levels were higher in oral (22; IQR, 16-28 mg/L) than IV (20; IQR, 17-22 mg/L) group (median difference 7.0; 4.0-8.0 mg/L; P = .0001). CONCLUSIONS: Opioid-sparing effects did not differ following an oral or standard IV acetaminophen loading dose with no identified acetaminophen toxicity in pediatric patients undergoing tonsillectomy and adenoidectomy who received standardized multimodal postoperative analgesia. An oral loading dose may provide more consistent serum acetaminophen levels at lower cost compared to a standard IV dose.