A community of 30,000 US Transcriptionist serving Medical Transcription Industry

To poster promoting instant TAT. - sm

Posted: Jan 25, 2011

I was just reading an article on 98,000 annual deaths, and those were due to medical harm, like hospital-acquired infections, careless surgeries, and incorrect medication orders. In that article there is only one mention that has to do with healthcare information technology, and it wasn't MT or VR. It was about electronic prescription orders to prevent medication errors due to sloppy handwriting and harmful drug interactions. Not once is it mentioned about deliquent charting or not getting information in a timely manner. Everything that they cite has to do with DOCTOR error, not HIT error.

Another poster below pointed out that when it comes down to instant need for information regarding lfe or death, most physicians call for this. They don't wait for the doctor to dictate a note, wait for the note to be transcribed or edited, and then wait for the note to hit the chart. There are too many steps in that process where even instant TAT wouldn't help. The charting information is generally documentation on what was discussed in phone calls when emergencies arise.

Our job as MTs and editors is mainly for the billing purposes. Administrators want instant TAT on all jobs because it makes billing easier, NOT because of patient safety. We would like to think that our jobs holds that kind of power, but it doesn't. That's exactly why hospital administrators feel we are expendable.

I work for small MTSO and asked about this. Was told that at - times, care is held up waiting SM

[ In Reply To ..]
for print documentation, as in the case of needing H&P 5 min ago b/c pt is going to surgery. Or for a follow up visit where pt was seen day before. But also was told that these reports are also for insurance purposes.

Exactly, something like this would be a stat, but... - sm

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to ask for every single dictated report to be 0 TAT or instant TAT is ridiculous. IMO, when a facility administrator wants or an MTSO offers 1-hour TAT or less for quicker billing purposes, that's what is dangerous. Unless the facility is using some sort of electronic charting system, paperwork is piled up waiting for charting and the critical stat reports are held up with the quick billing reports. It defeats the purpose.

MTSOs love it because they can bill more for shorter TAT and then they overhire to cover it. When there isn't enough work to go around, they save on full-time benefits. So, they're getting paid more per low-TAT report, paying us the same amount, AND saving by not having to pay us benefits.

I agree, just want to share what my small MTSO told me. - nm

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x

P.S. forgot to add - sm

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I would be furious if my appendix burst or I waited in pain for a C-section because my doctor was waiting for a printed H&P when he could have very easily called the doctor who did the H&P to find out if I was cleared for surgery or not.

I said 0 TAT was an ideal, not that this impossible - standard was being called for.

[ In Reply To ..]
It is definitely being worked toward, however. Medical records and patient care are not about IT, IT is about patient care.

As for the notion that having no readable list of medications available would have nothing to do with the many tens of thousands of patient deaths each year from medication errors--huh?

Or the notion that clinicians would always be able to just call each other for information instead of reading the chart. Even presuming one knew he was about to make a fatal error he hadn't thought about (good trick) and decided to, heck, to place a call to one of the others on the case (to shoot the breeze since he didn't actually have a question?), why would the other physician automatically be available to take it?

This stuff is not just important, it's most important while a patient is being cared for and decisions made, not afterward.

I've worked in a lot of medical offices where this is done. - Just Me

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Plenty of times we had to notify the doctor that Dr. So-n-so was on the phone. He would either take the call or call them right back. Even when a patient in different offices this has happened while the doctor was in the room with me at the time. It's not that unusual.

I used to work for a paging service and this was done ALL THE TIME. - Hayseed

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Morning, noon, middle of the night, even if the doctor who had the answer to a question was on vacation...if there was important/urgent enough, a page/call was placed. No waiting for dictation. It's almost silly when you really think about it.

I've had my bosses tell me this too, "Get that report out right now because the patient is waiting for surgery...or life flight...or whatever."

It's all bullhockey. They are in jeopardy of not meeting their contracted TAT and are about to lose money. It's all about the Benjamins.

You guys're missing the point. Hospitals are dangerous. - Oh, me.

[ In Reply To ..]
Let's try again:

2004: "An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records that was released today by HealthGrades, the healthcare quality company."

2009: "Preventable medical mistakes and infections are responsible for about 200,000 deaths in the U.S. each year, according to an investigation by the Hearst media corporation. The report comes 10 years after the Institute of Medicine's "To Err Is Human" analysis, which found that 44,000 to 98,000 people were dying annually due to these errors and called for the medical community and government to cut that number in half by 2004."

Please note: These are only estimates as many states do not require records be kept and the guilty prefer to keep their secrets. They are estimates only of DEATHS in HOSPITALS. Whatever the correct numbers are, lower or higher, the actual number of patients badly hurt by medical error is dreadfully higher.

(Explaining a bad phone call joke: The vast majority of these deaths are ACCIDENTAL, caused by people who probably didn't realize there was something to call about in the first place. In other words, typically no calls placed, no calls answered.)

Think about this when reading your last sentence again. - Just Me

[ In Reply To ..]
It isn't the MR document or lack thereof that is causing this. If those people who are physically with the patient didn't realize there was something to call about in the first place, they wouldn't have caught it on a medical record either.

Also, most of these deaths in hospitals due to medical errors are due to the errors of doctors, not the medical records not being turned around in 0 time. If you're trying to imply that deaths are caused by errors in medical records, it has nothing to do with how quickly the records get to the chart. If that's the case, having ALL records there in 0 TAT is just going to contribute to that.

YOU missed the point of this thread, which is fast - TAT, not hospital danger in general. nm

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x

All I can say is I have no trouble reconciling my need to - make money and my concern for good patient care. N

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x

Okaaay, but still not relevant to this thread. - nm

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x

:) It may have taken on its own life, but I sort of - thought it was directed to me.

[ In Reply To ..]
I did say 0 TAT would be ideal, although unachievable with today's technology, mercifully for us. However, no matter what, TAT is about patient care. (And also about billing, but I don't worry about that. At all.)

Joint Commission - ICManiac

[ In Reply To ..]
JC comes in to do audits of hopsital on a regular basis to give hospitals accreditation. Only hospitals with JC accreditation are eligible for certain funding (namely, governmental). If accreditation is lost, so is funding.

One part of a JC audit is to track the TAT of documentation (reports, MARs, prescriptions, etc.). TAT is one part of the JC audit and does not carry that much weight in the overall score; however, administrators don't want that part of their audit to pull down the score when there are so many other thing to have to worry about. JC sets up standards for when the document should be on the chart. They state that having the document on the chart in and of itself is not the critical element, but rather a way to gauge the level of care patients are receiving.

So when MTs feel MTSOs are over promising fast TATs to clients and using an overseas workforce to meet those unrealistic promises, keep in mind that right here at home the JC is holding those clients to a standard that directly impacts funding.

Joint Commission has never specified 0 or instant TAT. - see inside for their recs

[ In Reply To ..]
MTSOs are again spinning information to benefit the MTSO and certain facility requests for instant TAT. If a facility is requesting instant TAT so that their audit score is not pulled down, especially since the TAT in the audit score does not carry that much weight in the overall score (your words),I would be very suspicious about that facility trying to cover up things in their audits that would bring the overall score down.

The Joint Commission does not comprehensively address transcription practices or specify the timeliness and TATs of transcribed documents.

According to their own Standard P.C.2.120: "History and Physical Completion, for example, requires a hospital to â��define in writing the time frame(s) for conducting the initial assessment(s)â�� and requires a history and physical examination â��to be completed within no more than 24 hours of inpatient admissionâ��1 but falls short of recommending the use of dictation and transcription services or specifying the timeframes under which the result should be made available. Standard IM.6.10 goes on to stipulate that â��the hospital has a complete and accurate medical record for patients assessed, cared for, treated, or servedâ�� and requires a â��policy on the timely entry of information, again without specifying the mechanism by which the records are to be produced."

talk about a spin - ICManiac

[ In Reply To ..]
I can only relate my own personal experience when I was involved in 2 JC audits. I met the auditors, shook their hands, made refreshments available, pulled the charts, refiled the charts and read the audit document.

They certainly do score on timeliness of documentation. Of course, your experience may vary.

I'm not spinning it. It's JCAHO (now TJC) information, not mine. (sm) - see inside for recs

[ In Reply To ..]
I didn't say that they don't score on timeliness of documentation. In fact, it states 24 hours in the information I posted. Anything beyond the 24 hours would have been scored against.

What I was saying was that 0 TAT or instant TAT would not be a qualification for a bad score in documentation auditing, so I don't see how Joint Commission would play a factor in the facility requesting instant TAT.

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