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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
Summary
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.
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