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North Glasgow – what were the reasons for discrepancies between SMR01 and audit data

North Glasgow – what were the reasons for discrepancies between SMR01 and audit data. Dr M Taylor, Dr C McAlpine, Department of Geriatric Medicine, Stobhill Hospital, Glasgow. Background.

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North Glasgow – what were the reasons for discrepancies between SMR01 and audit data

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  1. North Glasgow – what were the reasons for discrepancies between SMR01 and audit data Dr M Taylor, Dr C McAlpine, Department of Geriatric Medicine, Stobhill Hospital, Glasgow

  2. Background • ISD (Information Services Division) collects data on the number of patients treated for stroke and the procedures they receive • This together with data on deaths allows ISD to monitor mortality, incidence and treatment of stroke • SSCAS uses ISD data as a comparison

  3. Background • ISD and SSCAS class cerebrovascular disease as follows (according to ICD-10): • CVD I60-9, G45 • Stroke I61-4 • SAH I60 • TIA G45

  4. Background • Inconsistency in coding can result in incomparability of data • Can be caused by misunderstanding of rules by individual coders • Different methods and approaches to the collection of information at source • ISD has specific standards about quality of data

  5. Background • Looking at the SSCAS figures for last year it was thought that there were some discrepancies in the figures for Stobhill Hospital ( both the data collected and the ISD figures SSCAS had ) • This was thought to be the case even when accounting for strokes discharged under non-stroke physicians

  6. Background • Stobhill Hospital has an incremental discharge letter system (IDLS) that can code on immediate discharge • The IDLS is reviewed by the consultant and a final discharge letter is then formed • The IDLS system does not allow for adjustment of diagnosis • On reviewing the IDLS document many strokes were classified as G81.- (hemiplegia) rather than Stroke I61-4.-

  7. Aims • To look at the difference in IDLS coding and actual coding – could this be a source of error? • To try and account for any discrepancies in the recorded number of strokes according to ISD / SSCAS and the perceived number of strokes

  8. Methods • Data was gathered from discharge summaries over a 6 month period (Oct 2004 – March 2005) from the stroke service team • IDLS coding was recorded where applicable • I coded the discharge summaries according to ICD 10 • Actual Trust ICD 10 coding was then recorded in those deemed to have a diagnosis of stroke

  9. Results • 130 discharge summaries were evaluated in total from the stroke service

  10. Results - Demographics - Sex

  11. Results - Demographics - Age

  12. Results – Stroke type

  13. Results • IDLS was completed on 72 out 130 (55%) of discharges • 38 of those 72 (53%) strokes were not coded as stroke on IDLS • Of these 38, 26 (68%) were then coded by coding dept as stroke • 1 stroke on IDLS was coded as not stroke by coding department

  14. Results ICD 10 Comparison

  15. Results • 127 patients were classified as stroke disease when reviewing the discharge summaries compared to 45 according to SSCAS and 97 according to ISD (for a longer time period) • 13 patients who should have been coded as stroke according to discharge letter were not

  16. Conclusions • There are some areas which are of concern namely: • Large discrepancy between SSCAS stroke figures for Stobhill and our figures • Strokes being coded as hemiplegia (G81.-), dysarthria (R47.1) and collapse (R55.X) which are symptom related codes as opposed to disease related • G45.- (TIA) used instead of I61-4 (Stroke) • Strokes not being classed as any form of cerebrovascular disease at all

  17. What have I gained from this? • Coding is an important issue (not boring as I previously thought!) • Implications for future healthcare resources and planning if data incorrect • There are several potential sources of error in the data collection / coding process

  18. Further Plans • To review IDLS coding at Stobhill • To suggest that hemiplegia (G81) is not selected as stroke on IDLS • To look further into where the SSCAS team gain their figures from for Stobhill • To look at other stroke departments throughout the Trust

  19. Any Questions?

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