So, what’s this Clinical Coding thing, and how can it help to improve the care of patients with AKI?
All hospitals have a Clinical Coding Department, usually hidden away somewhere, and not many people know what it does, or what it’s for. Put simply Coders turn written information about a patient into a coded format so that it can be easily analysed and used for a number of purposes. A Clinical Coder is an expert in abstracting this information from the patient’s case notes and any electronic systems, understanding what it means, and turning it into coded descriptions of the patient’s clinical condition, as well as operations or procedures they may have had. It’s really important that the information contained in the patient’s notes is accurate and relevant, so the coder can accurately represent the patient’s clinical condition in code.
We use two different classifications of code – ICD (International Classification of Diseases) for the diagnostic coding, and OPCS (Classification of Interventions and Procedures) for any operations or tests. The diagnostic codes, as the name suggests, are international, so the code for Acute Kidney Injury (N17.9 to be precise) is the same all over the world. The coded data has many uses, both clinical and statistical
- a doctor can use it to review all his patients with a certain condition or procedure
- it can support studies of treatment effectiveness
- it can be used by commissioners to plan the healthcare they need to provide to their local area
- it is used in cost analysis and as the basis for payment to healthcare providers. The list goes on.
At Sheffield Teaching Hospital NHS Foundation Trust we have been working on a hospital-wide project to improve the care of patients with AKI, and to increase the level of knowledge amongst clinicians on early detection and appropriate treatment. We have a systematic programme of education for nursing and medical staff, and this is being rolled out across the organisation. How can we know whether this is being effective? This is where the Clinical Coding can help……
We have been able to take a baseline measure from the coded information, showing the rate of AKI picked up and treated in each specialty before the project began, and can track the improvement as the project is rolled out across the different specialties. An example is in Care of the Elderly, where the baseline period showed that 11.8% of discharged patients had been coded with AKI. In the period following the roll-out of the education programme, lab alerts and the introduction of an AKI Care Bundle, the rate of AKI coding increased to 19.1%. We are seeing similar positive results in all specialties where the project has been rolled out.
In time we will be able to analyse the data to see whether we have improved things like the length of stay and mortality. We have also been able to use the project to increase awareness of the need to keep accurate and legible patient records. This is really important to Coding – if it’s not in the patient’s notes we can’t code it, and if we don’t code it we might be missing a vital piece of information about that patient’s condition. If you are interested in Coding, I would encourage you to make contact with your Coding Department. Coders are a very friendly bunch, and will be delighted to show you what they do!
Andrea Watson
Andrea is the Improvement and Development Manager for Clinical Data Capture at Sheffield Teaching Hospital NHS Foundation Trust, and is a member of the Trust’s AKI Project Team.
Andrea trained as a nurse at the Sheffield School of Nursing, and has worked in varied roles throughout her career, including Project Nurse for the Resource Management Project, Service Manager for General and Plastic Surgery and Project Director for the Trust’s programme within the National Orthopaedic Project.