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Pediatric Inpatient Problem List Review and Accuracy Improvement

Nancy Liao1,2, Rena Kasick3,2, Karen Allen3,2

  • 1Nationwide Children's Hospital, Columbus, Ohio; and nancy.liao@nationwidechildrens.org.

Hospital Pediatrics
|October 14, 2020
PubMed

Insights

Improving the problem list (PL) review rate for hospital inpatients increased from 70% to 90%, enhancing patient safety and communication. This quality improvement initiative also reduced duplicate and unresolved diagnoses, boosting electronic health record data accuracy.

Area of Science:

  • Healthcare Quality Improvement
  • Electronic Health Records
  • Patient Safety

Background:

  • The problem list (PL) is crucial for electronic health record (EHR) documentation and provider communication.
  • Inconsistent or inaccurate PLs can lead to diagnostic delays and patient safety events.
  • The study focused on improving PL review and accuracy in pediatric and infectious disease services.

Purpose of the Study:

  • To increase the rate of PL review by attending physicians from 70% to 80% for discharged inpatients.
  • To sustain the improved PL review rate for at least 6 months.
  • To decrease the rate of duplicate and unresolved (red code) diagnoses in the PL to 5%.

Main Methods:

  • A quality improvement team utilized the Institute for Healthcare Improvement Model for Improvement.
  • Duplicate and red codes were tracked as indicators of PL quality.
  • Monthly analysis of PL review and quality rates was performed using statistical process control charts.

Main Results:

  • PL review rate increased from a baseline of 70% to 90% and was sustained for one year.
  • Duplicate codes at discharge decreased from 12% to 6%.
  • Red codes decreased from a baseline of 11% to 6%.

Conclusions:

  • The problem list is an underutilized but vital communication tool.
  • Engaging stakeholders, incentivizing compliance, standardizing management, EHR enhancements, and physician feedback improved PL meaningful use and quality.
  • The implemented strategies successfully enhanced both the utilization and accuracy of the problem list.
Abstract

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