The bariatric multi-disciplinary team meeting: A useful resource or a source of delay?

Abstract

s / International Journal of Surgery 12 (2014) S13eS117 S99 0224: AUDIT OF CLINICAL CODING ACCURACY FOR LAPAROSCOPIC CHOLECYSTECTOMY e ROOM FOR IMPROVEMENT? KellyHaldane, Yik L. Pang, EmmaL. Court .North Bristol NHS Trust, Bristol, UK. Introduction: Accurate clinical codingensures correct remuneration through Payment by Results. Data quality depends upon comprehensive clinical notes for each admission. This study aimed to identify clinical coding errors for patients undergoing laparoscopic cholecystectomy in our NHS Trust. Methods: Notes of 19 consecutive elective and 18 emergency laparoscopic cholecystectomy patients (15M, 22F, range 25-79 years) across two hospitals were retrospectively reviewed. Operations, procedures and co-morbidities detailed in notes for the laparoscopic cholecystectomy admission were recorded. Clinical coding data for each admission was obtained from Coding and IT Departments. The two data sets were then compared. Results: Recording of operations/procedures performed was correct in all 37 cases. Co-morbidity coding data omissions among the elective cohort was 9/19 cases (47.4%) and 8/18 (44.4%) emergency cases. The commonest omissions were cardiovascular disease, respiratory disease, gastrointestinal disease and obesity. There were no diabetic coding errors. The payment deficit for incorrect coding was £3087.58. Conclusions: The accuracy of operation/procedural codings in our study may be linked to the WHO theatre checklist, which verifies the procedure name. However, accuracy of co-morbidity coding data was poor. We recommend clinical coding education sessions for doctors and introduction of a mandatory co-morbidities section in the electronic discharge summary programme. 0479: THE BARIATRIC MULTI-DISCIPLINARY TEAM MEETING: A USEFUL RESOURCE OR A SOURCE OF DELAY? Naomi Bullen , Jeremy Gilbert, Michael Clarke, Allwyn Cota, Ian Finlay. Royal Cornwall Hospitals Bariatric and Metabolic Surgery Unit, Truro, UK. Introduction: Multi-Disciplinary Team meetings (MDT) are recommended for management of bariatric surgery patients despite limited evidence for their effectiveness. This study assessed the impact of the MDT upon patient care decisions and delays in treatment. Methods: A retrospective case note analysis of MDT decisions between Feb 2012 July 2013 was performed. PreMDTopinions of surgeon, anaesthetist and dieticianwere compared with subsequent MDT decisions. Consequent delays to treatment were also recorded. Results: 200 patient's notes were analysed. Pre MDT opinions by the surgeons were that 176/200 (88%) patients should proceed to surgery and 24 (12%) required further investigation. There was MDT agreement in 115/ 176 (65.3%) but disagreement in 61/176 (34.7%). In 34/176 (19.3%) anaesthetist opinion differed, and in 55/176 (31.2%) dietician’s opinion differed. Mean delays to treatment resulting from MDT inspired interventions / investigations were 95 days. Conclusions: The MDT approach resulted in a change in decision for a significant number of patients (34.7%). This can be interpreted as resulting in improved quality of care for these patients however this was at the expense of a mean 95 days delay to treatment. We conclude that the MDT approach is clinically valuable, and have identified areas for reducing subsequent delays. 0483: CAN WE ACCEPT LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG) AS A SINGLE STAGE BARIATRIC PROCEDURE? A SYSTEMATIC REVIEW Ahmed Ahmed , Mohamed Eltom, Bijendra Patel. Barts Cancer Institute,