Review of Non-Surgical Procedures in Medical Wards : From Utilization Review Results to Process Improvement

Abstract

The Department of Medicine Utilization Review Committee undertook review of non-surgical procedures performed for in-patients in medical wards by examining records, results of orders, results and charges for 4 representative wards during a one-month period. Altogether 45 procedures were performed. Adequate documentations were identified in only 51.06% and 83.7% of order sheets and nurse progress notes, respectively. Loss incurred by failure to charge accounted for 11.82% of total charges. The 3 highest loss rates pertained to oxygen therapy, EKG, and Hudson's nebulizer treatment. After a period of intensive campaigning as well as procedural record sheet implementation, the loss in charge was reduced to 7.98% while the completeness of documentation increased to 67.7% and 84.6% in order sheets and nurse progress notes, respectively. Among all procedures, EKG was the only one without improvement. This, a 2-month pilot study was then began to compare the loss rate between the usual EKG process done by ward staffs and one done by EKG nurses. The result showed near total completeness of documentation and charges, and a significantly increased net income. We concluded that utilization review should be performed routinely and results should enable an organization to take actual steps to modify its process in order to best use its resources.