A continuous quality improvement approach to IL-372 documentation compliance in an academic emergency department, and its impact on dictation costs, billing practices, and average patient length of stay

Objective: To determine whether continuous quality improvement (CQI) method ology could improve and maintain IL-372 documentation compliance in an acad emic emergency department (ED). The impact on transcription costs, billing practices, and average patient length of stay was also analyzed. Methods: B aseline IL-372 compliance data were collected and shared with staff during a multidisciplinary educational session. Faculty dictation became mandatory . Pocket-sized dictation templates were provided. A Documentation Improveme nt Committee monitored outcomes. Each month of the study period, a complian ce officer reviewed approximately 100 records. The following indicators wer e monitored: IL-372 compliance rates, dictation rates, transcription costs, down-coding rates, percentage of billable records, and average patient len gth of stay. Individualized results were provided to faculty. Results: Duri ng the ten-month study period, compliance rates increased from 60% to 100% (p-trend < 0.001), while dictation rates increased from 69% to 100% (p < 0. 001). Rates of down-coding adjustments improved from 54% to 2% (p-trend < 0 .001). The percentage of billable records increased from 65% to 100% (p-tre nd < 0.001). Transcription costs increased a modest 16%. The average patien t length of stay remained unchanged. Conclusion: The application of CQI met hodology, combined with the availability of dictation, resulted in sustaine d improvement in IL-372 compliance. This was associated with a parallel inc rease in dictation rates, although concurrent transcription costs increased only modestly. The percentage of billable records increased, while the num ber of charts requiring down-coding decreased, both beneficial outcomes. Av erage length of stay was not adversely impacted by this added documentation requirement.