Healthcare is famous for its silos — mutually isolated operating units that prevent information sharing and create duplicate work.
At Salem Hospital, a Level II trauma center in Salem, Oregon, leaders from the trauma program and the charge capture team have built a unique cross-department collaboration that strengthens the work of both teams.
Kathy Tompkins, BS, RN, CCRN-K, CPAN, trauma performance improvement and patient safety coordinator, said the partnership has improved trauma data quality, accelerated PI follow-up and increased billing accuracy.
Tompkins recently described how the two teams work together.
1. Business intelligence converts EHR data to trauma patient report
Care teams at Salem Hospital document trauma patient data using the Epic Trauma Narrator electronic trauma flowsheet. Documentation includes each patient’s trauma band number — a unique identifier (required by the State of Oregon) assigned in the field by EMS or in the emergency department by hospital staff.
Every night, the hospital’s business intelligence system uses trauma band numbers to pull key data on trauma patients from the EHR. The system then generates a spreadsheet report covering all trauma patients seen in the previous 24 hours. Beyond patient demographics, the report captures data tied to PI audit filters and trauma registry fields.
The system automatically emails the report to the trauma program’s two PI coordinators and to key charge capture personnel.
2. Charge capture team reviews report for errors, missing information
Charge capture staff perform the first review of the daily trauma patient report.
A nurse reviewer on the charge capture team examines the spreadsheet for documentation errors or gaps (for example, missing activation or upgrade times) that could affect billing. The reviewer then creates a summary and emails it to both the trauma PI team and trauma registry staff.
The summary also includes the reviewer’s notes on patient injuries and injury mechanisms, and it flags any trauma patients transferred to another facility.
3. PI team uses charge capture review to prioritize follow-up
The charge capture summary gives the trauma PI team two immediate advantages.
First, it allows PI coordinators to act quickly on issues affecting data quality, care quality or trauma revenue.
“For example, if the report flags a missing trauma activation time, I can send a follow-up email to the nurse and note the incomplete documentation,” Tompkins said. “And because I can do that in literally a 12- to 24-hour time frame, it will be easy for the nurse to verify when they received that trauma activation. If I do it 60 days from now, they won’t know, will they?”
Second, it helps the PI team identify cases with potential PI implications.
“When I come to work in the morning I can look at the injuries that the nurse reviewer has noted, and it’s like, ‘Oh, this looks like a big trauma, I need to get my eyes on it right now’ or ‘This patient was transferred out, I need to look at that right away,” Tompkins said. “It just helps me narrow my focus.”
Kaizen in trauma
The collaboration grew out of Salem Hospital’s commitment to Kaizen, which is a continuous improvement philosophy that emphasizes simplifying work and eliminating duplication and waste.
“The focus is on working smarter not harder,” Tompkins said. “For us in the trauma program, this collaboration lets us take advantage of an extra pair of eyes.”