Implementation Of Stroke Templates And Enhanced Trainee Education In An Academic Hospital Improved Data Capture Of Risk Variables And Reduced Hospital Costs.

Background: Effective medical record documentation is required to support accurate capture of diagnoses and reflect true patient acuity (case mix index [CMI]) related to resource utilization for healthcare reimbursement. Increasing complexity and expansion in billing codes combined with the lack of a documentation education component in provider training programs has created a need for academic medical centers to incorporate training for new residents and nurse practitioners. We hypothesized that standardized stroke templates combined with formal education of trainees and feedback from chart audits would improve costs and documentation accuracy (increase expected length of stay (LOS), CMI). Purpose: To design and implement ischemic and hemorrhagic stroke templates with high frequency complication and comorbidity diagnoses that have the greatest impact on stroke populations, combined with trainee education and real-time chart audits, to improve the capture and accuracy of Vizient risk variables (LOS, CMI). Methods: Descriptive statistics were used to analyze outcomes before and after implementation of the templates. The outcomes include expected (E) LOS and observed (O) LOS. The O/E ratio and variance days (O-E) were calculated. Cost avoidance was calculated by multiplying the terminal day total cost by the variance days. The Wilcoxon rank sum test was used to compare groups with significance set at p<0.05. Analyses were performed using SAS 9.4. Results: The post-template group demonstrated significant improvement in all outcomes. The ELOS showed the most improvement contributing to the reduction in the O/E LOS. Cost avoidance increased from $24.49 to $1,897.01 per patient, yielding a net cost avoidance of $1,252,373.02. Conclusions: Stroke-specific templates, combined with trainee education and chart audits, significantly improves the accuracy of documentation and addresses the importance of quality and efficiency in healthcare reform.