2006 OPEN FORUM Abstracts
CLINICAL INTELLIGENCE IN RESPIRATORY CARE: BENEFITS OF USING AUTOMATED TOOLS FOR IMPROVING REVENUE CAPTURE AND MONITORING CLINICAL DOCUMENTATION COMPLIANCE
Dexter D'Costa, MBBS, MHA,
Dan Murphy, MS, RRT-NPS, St.Louis
Children's Hospital, St.Louis, MO.
Background:
The adoption of clinical documentation systems is increasing in healthcare
organizations. Electronic charting is now becoming an integral component of a
majority of respiratory care departments. There is an urgent need to develop
tools that provide respiratory care managers with the ability to effectively
monitor clinical documentation compliance. The project evaluated the use of
automated tools for improving revenue capture and monitoring clinical
documentation compliance in respiratory care.
Methods: The
project utilized an integrated querying, reporting and analysis tool called 'Business
Objects Desktop Intelligence'. The automated tool performed queries on clinical
documentation done by respiratory care staff. Existing audit methods included
manual chart audits that were very time-consuming and ineffective for
monitoring compliance. The primary objective of the project was to improve the
accurate capture of revenue charges associated with respiratory documentation.
The project began in November 2005 and was evaluated over a six-month period. Respiratory
care coordinators had access to automated reports at the end of every shift to
monitor compliance. Numerous change management processes were introduced to enhance
the role of automated reports. A monthly Respiratory Care Scorecard was developed
to provide feedback on revenue capture compliance. Staff meetings were held
periodically to educate respiratory care staff on their performance. Mobile
wireless computers were provided to staff to address the issue of device
availability and promote point-of-care documentation.
Results: Automated
reports provided the respiratory care coordinators with a real-time monitoring
tool to ensure accurate capture of revenue charges associated with respiratory
documentation. The number of missed respiratory treatment charges decreased
significantly from 265 in November 2005 to 13 in April 2006 (a 95%
improvement). This amounted to additional monthly revenue capture of approximately
10,000 dollars for the respiratory care department. Automated reports helped
provide respiratory care staff with feedback/education on their documentation
practices. It also provided the impetus for implementing a major re-design of
the respiratory care documentation module in May 2006 to improve revenue
capture and enhance respiratory workflow. The following table shows the
improvement in revenue capture:
| Month/Year | No. of Missed RT Txs | Dollar Equivalent |
| November 2005 | 265 | $10,390 |
| December 2005 | 92 | $4,050 |
| January 2006 | 23 | $1,010 |
| February 2006 | 32 | $1,341 |
| March 2006 | 33 | $1,355 |
| April 2006 | 13 | $468 |
Conclusions:
Automated tools have a significant role to play as respiratory care departments
adopt clinical documentation systems. This needs to be coupled with change
management processes that facilitate staff buy-in as well as support respiratory
workflow. Respiratory care departments need to invest in 'Clinical
Intelligence' to facilitate the effective monitoring of clinical documentation
compliance in real-time and thus improve revenue capture.