Redesigning case selection methods to improve clinical review of inpatient medical records

Abstract Background The objective was to redesign selection criteria for readmission cases to improve pick up rates of adverse events* for clinical reviews of inpatient medical records using a new methodology. *Adverse events: An unintended injury or complication resulting in increased length of hospital stay, temporary/permanent disability/death, caused by healthcare management. Level 1 AE's: Unpreventable events only for information of clinical departments. Level 2 AE's: Preventable/potentially preventable events reported to Heads of clinical departments. 1 , 2a Trigger tools: The use of "triggers", or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm in a health care organization. 2b PDSA: An iterative four-step management method used for continuous improvement of processes. 3 Methods Selected screening criteria were applied in a series of quality improvement cycles with further modification to eliminate unnecessary cases. A checklist to simplify screening was implemented and a staff satisfaction survey conducted to check process efficacy. Results Modification of selection criteria continuously improved review quality and accounted for better time management by the team. Conclusion The project resulted in a significant increase in the total AE pick up rate of 94.23% as compared to the baseline of 80%. The level 1 and 2 AE rates also increased to 92.31% and 1.92% from the baseline rates of 75% and 0.2%. There was also noted to be a significant decrease of 80.98% in review time taken. These findings support the fact that an effective screening process for readmission review is beneficial and worth implementing.