Documentation Errors Research Articles

Identification of medication discrepancies during hospital admission in Jordan: Prevalence and risk factors

ObjectivesMedication errors are considered among the most common causes of morbidity and mortality in hospital setting. Among these errors are discrepancies identified during transfer of patients from one care unit to another, from one physician care to another, or upon patient discharge. Thus, the aims of this study were to identify the prevalence and types of medication discrepancies at the time of hospital admission to a tertiary care teaching hospital in Jordan and to identify risk factors affecting the occurrence of these discrepancies. MethodsA three months prospective observational study was conducted at the department of internal medicine at Jordan university hospital. During the study period, 200 patients were selected using convenience sampling, and a pre-prepared data collection form was used for data collection. Later, a comparison between the pre-admission and admission medication was conducted to identify any possible discrepancies, and all of these discrepancies were discussed with the responsible resident to classify them into intentional (documentation errors) or unintentional. Linear regression analysis was performed to assess risk factors associated with the occurrence of unintentional discrepancies. ResultsA total of 412 medication discrepancies were identified at the time of hospital admission. Among them, 144 (35%) were identified as unintentional while the remaining 268 (65%) were identified as intentional discrepancies. Ninety-four patients (47%) were found to have at least one unintentional discrepancy and 92 patients (46%) had at least one documentation error. Among the unintentional discrepancies, 97 (67%) were found to be associated with a potential harm/deterioration to the patients. Increasing patients’ age (beta= 0.195, p-value= .013) and being treated by female residents (beta= 0.139, p-value= .045) were significantly associated with higher number of discrepancies. ConclusionThe prevalence of unintentional discrepancies at the time of hospital admission was alarmingly high. Majority of these discrepancies were associated with a potential harm to the patients. These findings support the necessity for implementing the medication reconciliation service in the country, engaging healthcare providers in the process of identification and resolution of medication discrepancies.

Lessons Learned From the VA Radiotherapy Incident Reporting and Analysis System (RIRAS)

The intranet Web-based RIRAS was developed and deployed in the Veterans Health Administration (VHA) System to collect adverse events and good catch data; analyze the causes and contributing factors; and find ways to prevent future occurrences at its 39 radiation oncology practices nationwide. 286 reports were electronically submitted to the RIRAS between 5/11/2014 and 1/02/2017. Each reported event included information on the incident chronology, general information specific to the treatment modality, site and intent and free text narrative. All reports were carefully analyzed by a radiation oncology subject matter expert (SME) and assigned to one of the eight discrete radiation oncology process steps. Steps relate to where the event was discovered and/or occurred. As part of the analysis, error type, medical and dosimetric severity, interventions and potential causes were recorded for each report. Patient safety work products (PSWP) created for these reports listed corrective, preventive and learning actions. For learning purposes, the anonymized version of each PSWP is publicly available on the RIRAS website, which enhances the safety culture. We completed causal analysis and developed corrective action plans for 100% of the reported incidents. Out of a total of 286 reports, 35% were actual events of which 3% met the criteria of VHA misadministration classification but with a low medical severity. 61% were good catches/ near misses, 4% were unsafe conditions. 32% of the reported events occurred in the treatment planning phase, 28% in the treatment delivery phase and 7% in the imaging for treatment verification phase. 31% of the events were discovered by the radiation physicist, 25% by the radiation therapist and 19% by the attending radiation oncologist. 32% of the events were related to organizational management issues like non-existent or inadequate policy and procedures. 31% were related to procedural issues such as distractions / loss of attention and poor documentation. 24% were human behavior related to poor judgement and lack of vigilance. 9% were based on technical issues such as lack of IT / biomedical attention. 36 reports were due to documentation errors, 11 based on previous RT treatment not taken into account for retreatment and 12 due to inconsistent patient setup instructions. Based on the analyses of reported incidents, we were able to make individualized recommendations for radiotherapy process improvement to enhance patient safety at each reporting facility. While RIRAS utilization is a marker of a positive safety culture within VHA, it is important to have a concrete plan for following up, learning and documenting process improvements from the reported events. We found that the ability to learn is significantly enhanced when the reporter is self-identified and there is an ability to request additional information on the event.

Medication Management in Schools: 2015 Survey Results.

The increasing prevalence of chronic conditions in children, for both common and rare conditions, over the past 30 years, and the increase in the number and range of medications used to manage these conditions, has contributed to the need to address medication management in schools. The purpose of this article is to present the key findings from a national survey on medication administration in schools. A nonexperimental cross-sectional design was used in this descriptive study. An online survey was sent to school nurses across the country. Responses from a total of 6,298 school nurses were used in the analysis. Results of the survey related to prescription and nonprescription medications, medication storage, student's carrying their medications, delegation of medication administration, documentation, and medication errors are discussed. The article concludes that many different medications are administered during the school day. School nurses must advocate for proper policies and procedures to guard the safety of students.

AUTOMATION OF TRACEABILITY PROCESS AT GRAIN TERMINAL LLC “ UKRTRANSAGRO"

A positive trend of growth in both grain production and export is indicated. In the current marketing year the export potential of the Ukrainian grain market is close to the record level. However, the high positions in the rating of world exporters are achieved not only due to the high export potential, but also because of higher quality and logistics. These factors depend directly on the quality of enterprise management and all processes occurring at it. One of the perspective ways of enterprise development is the implementation of the traceability system and further automation of the traceability process. European integration laws are obliging Ukrainian enterprises to have a traceability system. Traceability is an ability to follow the movement of a feed or food through specified stages of production, processing and distribution. The process of traceability is managing by people, which implies a human factor. Automation will allow, in a greater extent, to exclude the human factor that will mean decreasing of errors in documentation and will speed up the process of grain transshipment. Research work on the process was carried out on the most modern grain terminal - LLC “UkrTransAgro”. The terminal is located in the Ukrainian water area of the Azov Sea (Mariupol, Ukraine). Characteristics of the terminal: capacity of a simultaneous storage - 48,120 thousand tons, acceptance of crops from transport - 4,500 tons / day; acceptance of crops from railway transport - 3000 tons / day, transshipment capacity - up to 1.2 million tons per year, shipment to the sea vessels - 7000 tons / day. The analysis of the automation level of the grain terminal is carried out. The company uses software from 1C - «1C: Enterprise 8. Accounting for grain elevator, mill, and feed mill for Ukraine». This software is used for quantitative and qualitative registration at the elevator in accordance with industry guidelines and standards. The software product has many functions, but the management of the traceability process is implemented to a small extent. The traceability process at the grain terminal of LLC "UkrTransAgro" is considered and described. The expediency of development of the automated control system of the traceability process is justified. The organizational structure of the enterprise is analyzed. The process of traceability was divided into subprocesses. The process model of the traceability process is developed. The interfaces of the developed software are described. Functional part of interfaces considered. The further ways of modernization of the developed software are determined.

Identifying Factors and Root Causes Associated With Near-Miss or Safety Incidents in Patients Treated With Radiotherapy: A Case-Control Analysis.

To identify factors associated with a near-miss or safety incident (NMSI) in patients undergoing radiotherapy and identify common root causes of NMSIs and their relationship with incident severity. We retrospectively studied NMSIs filed between October 2014 and April 2016. We extracted patient-, treatment-, and disease-specific data from patients with an NMSI (n = 200; incident group) and a similar group of control patients (n = 200) matched in time, without an NMSI. A root cause and incident severity were determined for each NMSI. Univariable and multivariable analyses were performed to determine which specific factors were contributing to NMSIs. Multivariable logistic regression was used to determine root causes of NMSIs and their relationship with incident severity. NMSIs were associated with the following factors: head and neck sites (odds ratio [OR], 5.2; P = .01), image-guided intensity-modulated radiotherapy (OR, 3; P = .009), daily imaging (OR, 7; P < .001), and tumors staged as T2 (OR, 3.3; P = .004). Documentation and scheduling errors were the most common root causes (29%). Communication errors were more likely to affect patients ( P < .001), and technical treatment delivery errors were most associated with a higher severity score ( P = .005). Several treatment- and disease-specific factors were found to be associated with an NMSI. Overall, our results suggest that complexity (eg, head and neck, image-guided intensity-modulated radiotherapy, and daily imaging) might be a contributing factor for an NMSI. This promotes an idea of developing a more dedicated and robust quality assurance system for complex cases and highlights the importance of a strong reporting system to support a safety culture.

Intraoperative Handoffs Among Anesthesia Providers Increase the Incidence of Documentation Errors for Controlled Drugs

When electronic anesthesia records are compared to pharmacy transactions, discrepancies in total doses of controlled drugs are commonly found (≈16% of cases), potentially affecting patient safety and placing hospitals at risk for regulatory action. Errors (≈5%) persisted even with near real-time drug reconciliation feedback to providers. A study was conducted to test the hypothesis of greater risks of discrepancy for longer-duration cases and for intraoperative handoff involving a permanent handoff of care. Anesthesia drug documentation and pharmacy transaction data were examined for all anesthetics between May 2014 and September 2015 at an academic medical center, and discrepancies between the two systems were determined. Nine logistic regression models were constructed to evaluate the influence of covariates (for example, case duration, general anesthesia vs. sedation, and handoff involving a permanent transfer of patient care) on the presence of a discrepancy. Linear regression was also performed between case duration decile and the logit (discrepancy rate), stratified by anesthesia type and handoff. For all models, handoffs were associated with higher discrepancy rates (p <10-6; odds ≥ 1.38). There was a progressive increase in discrepancy rates as a function of the case duration. Handoffs involving a permanent transfer of patient care during cases increase the risk of controlled drug discrepancies. Staff scheduling and assignment decisions to decrease the chance of a handoff occurring should help mitigate this. In addition, future studies should examine ways to improve the handoff process related to controlled drugs (for example, a formal, structured processes in the anesthesia information management system).

The Utility of Continuous Temperature Monitoring of Refrigerators in a Long-Term Care Facility.

It is the current practice in most long-term care facilities to use manual logs when documenting refrigerator temperatures. This process is commonly associated with poor or fabricated compliance, little oversight, and documentation errors, both because of overt omissions and unsubstantiated values. It is also well-established that medication storage requirements are mandated by the Centers for Medicare & Medicaid Services (CMS). This analysis demonstrates the potential risk of poor cold-chain management of medications and establishes the possible utility of digitally recorded continuous temperature monitoring over manual logs. This small case-oriented review of a large nursing facility's storage process attempts to expose the risk associated with improper medication storage. The primary outcome of the study was to determine if a difference existed between temperature logs completed manually compared with those done with a continuous monitor. American Thermal Instruments (ATI) thermometers were placed into each of the existing refrigerators in a 147-bed nursing facility. Through a mobile app, the data recorded in each refrigerator were compiled into daily reports. Data were collected from a total of 12 refrigerators, 3 of which were medication refrigerators. Logging intervals were done over a 263-minute period and compiled the lowest recorded temperature, highest recorded temperature, and the average temperature for each refrigerator. In addition, reports showing the real-time results were compiled using the ATI DataNow service. All of the refrigerators analyzed had highest temperature recorded readings exceeding the maximum allowable temperature (50°F for refrigerator). All of the refrigerators had lowest temperature recorded readings below the minimum allowable temperature (32°F for refrigerators). All of the refrigerators also reported average temperatures outside of the allowable temperature range. The results necessitated the replacement of a refrigerator and the evaluation of a dairy refrigerator in the food service area. This resulted in consistent measurements within the allowable range. Following this analysis, it can be concluded that the common assumptions about the effectiveness of manual temperature logs should be verified. It can also be concluded that continuous temperature monitoring improves temperature-reporting accuracy. Proper medication storage is mandated by CMS; risk does exist that an improperly stored vaccine, biologic, or medication could lose effectiveness. While it has not been proven, improved medication storage offered from continuous monitoring could result in improved medication viability and hence improved patient outcomes associated with those medications.

Near miss or safety incident in patients treated with radiotherapy: What are the contributing factors?

36 Background: To identify 1) factors that are associated with a near miss or safety incident (NMSI) in patients undergoing radiation therapy; 2) the most common root causes of NMSIs and their relationship with incident severity. Methods: We retrospectively studied NMSIs filed between October 2014 and April 2016. We extracted patient-, treatment-, and disease-specific data from patients with a NMSI (n=200; incident group) and a similar group of control patients (n=200) matched in time, without a NMSI. A root cause was determined for each incident. A univariate analysis was performed to determine which patient-, disease-, and treatment-specific factors were different between the incident and control groups. Next, multivariate logistic regression was used to determine the significant factors contributing to NMSIs. Multivariate logistic regression was used to determine the most common root causes of NMSIs and their relationship with incident severity. A p value of 0.05 was used to test the statistical significance. Results: NMSIs were associated with the following factors: i) head and neck treated sites versus other disease sites (OR 5.2, p=0.01), ii) image-guided intensity modulated radiotherapy (IGIMRT) versus other treatment modalities (OR 3, p=0.009); tumors staged as T2 more frequently had incidents versus other T stages (OR 3.3, p=0.004), and iv) daily imaging versus no imaging or weekly imaging (OR 7, p&lt;0.001). Documentation and scheduling errors were the most common root causes (29%). Communication errors were more likely to affect patients (p&lt;0.0001) and technical treatment delivery errors were most associated with a higher severity score (p=0.005). Conclusions: Several treatment- and disease-specific factors were found to be associated with a NMSI. These factors are similar to what has been previously reported by others. Overall, our results suggest that complexity (e.g., head and neck, IGIMRT, T2, and daily imaging) might be a contributing factor for a NMSI. This promotes an idea of developing a more dedicated and robust QA system for complex cases. Our study highlights the importance of a strong reporting system to support a safety culture and promote continuous learning and improvement efforts.

How to evaluate the medical certification of death in a hospital: an analysis of 53 death certificates at AIIMS, Bhopal, India

Background: The AIIMS Bhopal has been established under PMSSY to provide the quality health care services. However, since the inception of hospital services from November 2014 till the month of October 2016 a total of 53 patients died due to various causes. The objective was to find out the different causes of death and its documentation at a tertiary care hospital in order to establish common causes of mortality and reporting errors in standard documentation of the death and feedback in this regard.Methods: This is a retrospective study with evaluation of death certificates in 53 deaths. The errors were analyzed as per the Haque’s scale and the scale devised by the authors.Results: The major cause of death reported was multiorgan failure where more than one system was affected As per the Haque’s scale the errors reported were for Grade 0 in 0%, Grade 1A in 31.03%,Grade 1B in 100%,Grade II in 79.31%,Grade III in 68.97%,Grade IV in 79.31% and Grade V in 62.07% of total death certificates.Conclusions: The certifying doctors must be adequately trained and/or fill the death certificate under the supervision of experts to ensure proper entries to avoid any kind of contraventions, confusion and conflicts.

The Impact of Information Culture on Patient Safety Outcomes. Development of a Structural Equation Model.

SummaryBackgroundAn organization’s information culture and information management practices create conditions for processing patient information in hospitals. Information management incidents are failures that could lead to adverse events for the patient if they are not detected.ObjectivesTo test a theoretical model that links information culture in acute care hospitals to information management incidents and patient safety outcomes.MethodsReason’s model for the stages of development of organizational accidents was applied. Study data were collected from a cross-sectional survey of 909 RNs who work in medical or surgical units at 32 acute care hospitals in Finland. Structural equation modeling was used to assess how well the hypothesized model fit the study data.ResultsFit indices indicated a good fit for the model. In total, 18 of the 32 paths tested were statistically significant. Documentation errors had the strongest total effect on patient safety outcomes. Organizational guidance positively affected information availability and utilization of electronic patient records, whereas the latter had the strongest total effect on the reduction of information delays.ConclusionsPatient safety outcomes are associated with information management incidents and information culture. Further, the dimensions of the information culture create work conditions that generate errors in hospitals.

The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia.

To provide an estimate of the numbers of medication errors and adverse drug reactions that occur along a person's journey through their hospital stay in Australia. A search of databases and online resources was undertaken to identify published literature on medication safety in the acute care setting in Australia from 2008 to 2013. Data on the rates of adverse drug reactions and medication errors associated with hospitalization was extracted from the published studies. This evidence was synthesized with evidence from previous reviews of medication safety in the acute care setting in Australia conducted in 2002 and 2008. Findings from the Australian literature across the two previous reviews of medication safety and the present review indicate the proportion of all hospital admissions that are medication-related is between 2 and 3%. Studies assessing medication errors on admission to hospital suggest there may be an overall rate of two errors for every three patients at the time of admission to hospital. Large studies examining the rates of prescribing errors in major Australian teaching hospitals give insight into the rates of prescription error and suggest that prescription error rates of up to one error per patient occur in the hospital system. The best available evidence from more recent research suggests that errors (excluding errors of timing) occur in around 9% of medication administrations in hospital. At hospital discharge, errors in medication documentation in discharge summaries may occur at a rate of up to two errors per patient. Medication safety in the various stages of the patient journey through acute care in Australia continues to be a significant problem. However, the extent of medication-related problems in acute care needs to be interpreted within the context of increasingly complex health care. There are an estimated 230 000 medication-related hospital admissions occurring per year. This suggests an annual cost of medication-related admissions of AU$1.2 billion.

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for Postoperative Respiratory Failure (PSI 11) does not identify accurately patients who received unsafe care

The Agency for Healthcare Research and Quality Patient Safety Indicator 11 is used to identify postoperative respiratory failure events and detect areas for quality improvement. This study examines the accuracy of Patient Safety Indicator 11 in identifying clinically valid patient safety events. All cases flagged for Patient Safety Indicator 11 from July 2013 to July 2015 by Agency for Healthcare Research and Quality QI Version 4.5 including International Classification of Diseases-9 codes were evaluated. Code-confirmed cases underwent independent review by 2 physicians. Inpatient electronic medical records were used to identify clinical factors for postoperative respiratory failure in each case to determine if postoperative respiratory failure was a result of unsafe care. The clinical true-positive rate and positive predictive value were calculated. A total of 166 postoperative respiratory failure cases were reviewed; 51 were recoded and reversed due to coding or documentation errors; 115 cases met the Agency for Healthcare Research and Quality definition of postoperative respiratory failure. A total of 71 (61.7%) of the 115 cases were false positives and did not reflect unsafe care, while 44 cases were true positives with a positive predictive value of 38.3%. χ(2) analysis did not reveal an association between demographics, clinical characteristics, or operative procedure with true-positive cases. Administrative coding data for Agency for Healthcare Research and Quality Patient Safety Indicator 11 do not identify accurately patients who received unsafe care when taking intoaccount unpreventable clinical factors causing postoperative respiratory failure. The use of Agency for Healthcare Research and Quality Patient Safety Indicator 11 as a hospital performance measure should be reconsidered until inclusion and exclusion criteria are revised.

Expert Opinion Cases - What documentation is necessary from a legal perspective?

Doctors are obliged by professional code and civil law (630 f German Civil Code [BGB] §) to document their medical activities in relation to patients. The documentation serves as proof of executed measures and thus for backing up medical/therapeutic issues. Documentation shall be made immediately after or during the treatment and if the original content remains recognizable, can be supplemented/modified. The patient record may be kept in paper form or in electronic form. Medical records are to be stored at least for 10 years. Some special laws (eg. laws governing X rays, Transfusion Act) require that documents be stored for longer periods. Documentation errors are - unlike patient information errors/medical malpractice - no basis for damages claims by the patient, but may result in medical malpractice process with the burden of proof in favor of the patient (§ 630 h BGB). The patient has, in principle, the right to inspect the medical documents relating to him.

When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship

BackgroundPatient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records...

Utilization of Interventional Techniques in Managing Chronic Pain In Medicare Population from 2000 to 2014: An Analysis of Patterns of Utilization

Background: The increase in the utilization of various techniques in managing chronic pain, including interventional techniques, is a major concern for policy-makers and the public at large. Consequently, multiple regulations have been instituted to reduce health care expenditures in general and expenditures related to interventional techniques in particular. Previous investigations have shown significant increases of utilization of interventional techniques across the board with minor decreases noted in 2007, 2010, 2012 and 2013. Objective: To assess the patterns of utilization of interventional techniques in chronic pain management in the fee-for-service (FFS) Medicare population. Study Design: Analysis of utilization patterns of interventional techniques from 2000 to 2014 in Fee-for-Services (FFS) Medicare beneficiaries in managing chronic pain. Methods: The analyzed data was derived from the Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary Master Data from 2000 to 2014. Results: The analysis of data from 2000 to 2014 in FFS Medicare beneficiaries showed overall utilization of interventional techniques increasing at a rate of 153% and an annual average growth rate of 6.9% per 100,000 Medicare population with increase in services of 242%. This showed a 3% decrease per 100,000 Medicare population, compared to the data from 2000 through 2013, even though services increased by 6% due to the increase in the number of Medicare recipients in the FFS beneficiary group. The overall increases in epidural and adhesiolysis procedures were 165% with a rate of 96% per 100,000 Medicare population with an average annual increase of 4.9%. Facet joint interventions and sacroiliac joint blocks increased at a rate of 313% per 100,000 population with an annual average increase of 10.7%. Disc procedures and other types of nerve blocks increased at a much lesser pace than epidural and adhesiolysis procedures or facet joint interventions with an increase of 54% per 100,000 Medicare population and annual increase of 3.1%. A decrease in utilization was noted in 5 of 14 years ranging from 1.2% to 3.8%. Limitations: The limitations of this updated utilization patterns of interventional techniques in managing chronic pain are multiple with lack of inclusion of participants from Medicare Advantage Plans, lack of complete and accurate data for statewide utilization, and potential errors in coding, billing, and documentation. Conclusion: This overall analysis of patterns of utilization in managing chronic pain with interventional techniques showed a continued and significant increase in FFS Medicare beneficiaries from 2000 to 2014 with an increase of 153% per 100,000 Medicare population and at a rate of 6.9% on average per year. However, there were decreases of 2.9% in 2007, 3.8% in 2010, and 1.3%, 3.4%, and 1.2% from 2012 to 2014. Key words: Interventional pain management, chronic spinal pain, interventional techniques, epidural injections, adhesiolysis, facet joint interventions, sacroiliac joint injections, disc procedures, other types of nerve blocks

Wrong intraocular lens events—what lessons have we learned? A review of incidents reported to the National Reporting and Learning System: 2010–2014 versus 2003–2010

PurposeTo identify the causal factors in wrong intraocular lens (IOL) events from a national data set and to compare with similar historical data (2003-2010) prior to mandatory checklist use, for the purpose of developing strategies to prevent never events.MethodsData from wrong IOL patient safety incidents (PSIs) submitted to the National Reporting and Learning System (2010-2014) were reviewed by thematic analysis and compared with the data previously collected by the group using the same methodology.ResultsOne hundred and seventy eight wrong IOL PSIs were identified. The contributory factors included: transcription errors (n=26); wrong patient biometry (n=21); wrong IOL selection (n=16); changes in planned procedure (n=16); incorrect IOL brought into theatre (n=11); left/right eye selection errors (n=9); communication errors (n=9); and positive/negative IOL power errors (n=9). In 44 PSIs, no causal factor was reported, limiting the learning value of such reports. Compared with the data from previous years, biometry errors were much reduced but IOL transcription and documentation errors were greater, particularly if further checks did not refer to the original source documentation. IOL exchange surgery was reported in 45 cases.ConclusionsThe selection and implantation of the correct IOL is a complex process which is not adequately addressed by existing checking procedures. Despite the introduction of surgical checklists, wrong IOL incidents continue to occur and are probably under-reported. Human or behavioural factors are heavily implicated in these errors and need to be addressed by novel approaches, including simulation training. There is also scope to further improve the quality and detail of incident reporting and analysis to enhance patient safety.

A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement

Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement. This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy. During period 1, traditional coding resulted in a 4.4% (P= .004) loss in reimbursement and a 5.4% (P= .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P= .24) or wRVUs (1.8% loss; P= .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P= .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes resulting in a higher overall reimbursement that was subsequently corrected. Assessment of physician documentation showed improvement, with decreased documentation errors at each period (11% vs 3.1% vs 0.6%; P= .02). Overall, between period 1 and period 3, multidisciplinary coding resulted in a significant increase in additional reimbursement ($17.63 per procedure; P=.004) and wRVUs (0.50 per procedure; P= .01). External validation at a second academic institution was performed to assess coding accuracy during period 1. Similar to institution 1, traditional coding revealed an 11% loss in reimbursement ($13,178 vs $14,630; P= .007) and a 12% loss in wRVU (293 vs 329; P= .01) compared with multidisciplinary coding. Physician involvement in the coding of endovascular procedures leads to improved procedural coding accuracy, increased wRVU assignments, and increased physician reimbursement.

An Assessment of Errors and Their Reduction in Terrestrial Laser Scanner Measurements in Marmorean Surfaces

The need for accurate documentation for the preservation of cultural heritage has prompted the use of terrestrial laser scanner (TLS) in this discipline. Its study in the heritage context has been focused on opaque surfaces with lambertian reflectance, while translucent and anisotropic materials remain a major challenge. The use of TLS for the mentioned materials is subject to significant distortion in measure due to the optical properties under the laser stimulation. The distortion makes the measurement by range not suitable for digital modelling in a wide range of cases. The purpose of this paper is to illustrate and discuss the deficiencies and their resulting errors in marmorean surfaces documentation using TLS based on time-of-flight and phase-shift. Also proposed in this paper is the reduction of error in depth measurement by adjustment of the incidence laser beam. The analysis is conducted by controlled experiments.

Study on Documentation of Medical Records

Documentation is the most essential part in Medical practice, it should be timely, accurate and complete. Whenever a case of medical negligence filed against a hospital, the only defence is medical record. Good records always provide a good defence. A cross sectional study was done on Medical record documentation at a rural medical college hospital, with an objective to appraise the importance of Medical record documentation with regard to various medico legal aspects. 100 case sheets were collected from the medical record department of the hospital and information from the case sheet was collected in to a data sheet and analysed for errors. None of the case sheet was free from documentation errors. We observed too many lacunae in the case sheets and explained how it leads to medico legal issues.

Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy

To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.