Redesign of diagnostic coding in pediatrics: from form-based to discharge letter linked

Diagnostic coding after hospital discharge is mainly based on abstracting of paper medical records by medical record coders. Studies show that the quality of these data is often moderate, possibly because discharge registries play no role in daily patient care. Timely writing of discharge letters is needed to support continuity of care, at least in the Netherlands. This article describes the redesign and evaluation of diagnosis registration and discharge letter writing at a Dutch pediatric department.Formerly, pediatricians at this department completed discharge forms. However, many forms were completed with insufficient information or not at all. Pediatricians now provide diagnoses with codes in a special heading of the discharge letter. The medical record coder checks and corrects this diagnosis heading. A list of diagnoses for pediatrics, based on ICD-9-CM, was developed and alphabetically ordered into one booklet used by pediatricians when dictating discharge letters. A reminder system for in-time writing of letters was implemented. Since 1995, this discharge letter-linked registration has proven to be applicable in daily care. How accurately pediatricians filled in the diagnosis heading was analyzed during two periods. In 1995, 25 percent of the diagnoses were initially (before adjustments made by the medical record coder) not coded or incorrectly coded; nine percent of these shortcomings could be attributed to the pediatricians. In 1997, 67 percent of the diagnoses were initially not coded or incorrectly coded; 37 percent of these shortcomings were attributable to pediatricians. Initially, only half of the letters were written within six weeks after discharge. The correction function of the medical record coder is indispensable.