Hospital codings were changed, report says
2:10pm Thursday 7th March 2013 in News
A REPORT following an investigation into data at the Royal Bolton Hospital has revealed some “codings” had been altered.
And it also showed that more than half of cases tested “did not meet national standards”, and 90 per cent of those cases had been “retrospectively changed” after they had been coded.
But there is no evidence in the report of patient care being compromised.
Bolton Clinical Commissioning Group was presented with Dr Foster’s final report into the clinical coding sepsis audit at Bolton NHS Foundation Trust yesterday.
CCG bosses commissioned the report after becoming concerned in October that the trust had recorded 800 cases of septicaemia between March, 2011 and April, 2012, when a similar sized trust would expect to have just 200.
Commissioners were worried the hospital either had an unusually large number of septicaemia cases, or the clinical coding had been altered.
Clinical codes are used to label diagnoses and procedures for patients after they have been treated.
The codes are used nationally and internationally for the monitoring of diseases and deaths and for health care strategic planning.
In the review, Dr Foster looked at 150 cases of septicaemia and found 76 did not meet coding standards or match patients’ notes.
Of these, 69 had been changed after they were coded.
The report did not explain why the codes had been changed or reveal whether it would have had an impact on the number of cases of septicaemia, or finances, as septicaemia cases receive more money than other infections.
It also did not reveal whether any of the cases were deaths and if this would affect mortality rates, which could have appeared lower than they actually were if deaths were coded inaccurately.
But the report has now led to more questions and the trust and Bolton CCG have jointly appointed an independent team to lead another investigation into the findings.
They have appointed Kathy Doran, an experienced chief executive, who currently works for Cheshire, Wirral and Warrington PCT cluster, to chair the review team.
Ms Doran has already begun the clinical review at the trust.
They have also appointed Dr Peter Williams, a medical director at Royal Liverpool and Broadgreen University Hospitals Trust.
Dr Williams is an experienced physician, and has been appointed to be the clinical lead on this review by the NHS Commissioning Board. He will be bringing an experienced team into the trust to help complete the review.
Dr Wirin Bhatiani, chairman of Bolton Clinical Commissioning Group, said: “The final report confirms that clinical coding of sepsis is of concern.
“This report looked at the quality of the coding process — we now need medical input to understand how and why this happened, and to understand if the coding was clinically appropriate.
“We have no evidence clinical care of patients has been compromised. We have jointly agreed with Bolton NHS Foundation Trust the scope of an independent, clinically-led review and the terms of reference with its chair David Wakefield.”
Su Long, Bolton CCG’s designate chief officer, said they were hoping to have initial findings about clinical processes “within weeks” and added these findings would determine the scope of the investigation, which may take longer and may involve more cases and larger time periods.
She said: “The coding doesn’t match the notes. We need to look at the codes and understand the decision making.
“It could be that the coders are right but there is a way they could have recoded it better. We will have to wait for the investigation to find out.”
Dr Foster co-founder and director of research Roger Taylor said: "We welcome the decision by Bolton Clinical Commissioning Group to more thoroughly investigate the concerns raised by our report.
“Coding data incorrectly can have serious implications on how we assess the quality of care being provided by hospitals."
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