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Analysis on the influence and countermeasures of ventilator operation errors in DRGs payment |
Gu Xiaomin1,Zhao Qing2 |
1 Medical Records Management Center, Huzhou Central Hospital, Huzhou 313000, China;
2 Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China |
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Abstract Objective To analyze the influence of incorrect filling of ventilator operation name on DRGs enrollment, improve the accuracy of operation name coding, and provide effective data support for the performance appraisal of tertiary public hospitals and medical insurance DRGs payment.Methods Based on HIS charging system, 936 medical records of patients discharged from a hospital using ventilators from July 1, 2021 to December 31, 2021 were retrieved. The contents related to ventilator operation in the first page of medical records were quality-controlled, the actual clinical writing and the coding of medical records were checked, and the wrong cases were corrected after summary and analysis. DRGs was simulated again and analyzed and compared.Results There were 936 medical records of patients discharged from the hospital using ventilators, and there were 17 with problems, including 8 with missing ventilator-related operation names, accounting for 47.06% with the defect rate 0.85%, 5 with writing errors in ventilator use time, accounting for 29.41% with the defect rate 0.53%, 2 with errors in writing/coding of ventilator types, accounting for 11.76% with the defect rate 0.21%, and 2 with coding of medical insurance, accounted for 11.76% with the defect rate 0.21%. After correction and with the simulation of DRGs, the filling error led to a big difference in the DRGs enrollment, the weight was reduced, and the hospital lost 892 378.87 yuan.Conclusion The errors in ventilator operation were mainly caused by the omission of operation name or the error of operation time by doctors and the coding errors of coders. It is necessary to establish an information monitoring system for the first page of medical records, strengthen the training of standardized filling in the first page of medical records, set up a threelevel quality control management team, and improve the accuracy of DRGs inclusion.
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Received: 19 July 2022
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