Question: Patient # Service Discharge Date Admit Date & Time Procedure Start Time Procedure End Time Physician Action Quality Code Notes 2 CD 12/23/14 12/23/2014;1230 12/23/2014;1620

Patient #

Service Discharge Date Admit Date & Time Procedure Start Time Procedure End Time Physician Action Quality Code Notes
2 CD 12/23/14 12/23/2014;1230 12/23/2014;1620 No time noted on update stamp
3 EN 12/04/14 12/04/2014; 0704 12/04/2014;0915 H&P dated June 2014
4 EN 12/10/14 12/10/2014;0647 12/10/2014;0844 No update stamp; signed, dated & timed at 0505
5 EN 12/19/14 12/19/14 12/19/2014;1426 Op report dictated 12/22
6 EN 12/09/14 12/07/201;0614 12/07/2014;0751 No date/time on limited exam
7 GS 12/26/14 12/26/14 H&P dated 11/24/2014
8 GS 12/26/14 12/26/14 12/26/2014;1408 Op report not dictated
9 GS 12/26/14 12/26/15 H&P dated 11/21/2014
10 GS 12/30/14 12/21/14 12/21/14 Op report dictated 01/09/15
11 NE 12/23/14 12/15/2014;0826 12/15/2014;1144 H&P dictated 12/18/2014
12 NE 12/20/14 12/18/2014;0526 12/18/2014;0725 12/18/2014;0845 H&P dictated 11/03/2014
13 NE 12/11/14 12/11/14 H&P dictated post-op
14 NE 12/16/14 12/16/2014;0456 12/16/2014;0751 H&P dictated 12/16; 0559
15 OB 12/23/14 12/25/2014;1642 Op report dictated 12/29/2014
16 OP 12/03/14 12/29/2014;1440 Op report dictated 12/29/2014;1500
17 OR 12/04/14 12/04/2014;0632 Op report dictated 12/23/2014
18 OR 12/17/14 12/17/2014;0952 12/17/2014;1247 H&P dictated 12/15
19 OR 12/18/14 12/15/2014;0514 12/15/2014:0739 Limited H&P completed 12/15;0730
20 OR 12/22/14 12/04/2014;1010 12/04/2014;1309 Limited H&P signed/dated/timed as 1100 after analysis
21 OR 12/06/14 12/03/2014;1710 12/03/2014;2346 No H&P dictated
22 OR 12/15/14 12/15/2014;1042 Op report dictated 12/16/2014;1055
23 UR 12/05/14 12/05/2014;0700 12/05/2014;0814 H&P update dated/timed 12/5; 0900 post analysis
Quality Code Key
1 = H&P >30 days
2 = No H&P prior to surgery
3 = No update to H&P prior to surgery

4 = No Operative report within 24 hours after surgery

1. Assign the appropriate quality code

2. Analyze the data. Which code is most common?

3. Is there one service that seems to be a problem?

4. What can you conclude from the data?

5. Establish a plan. How are you going to fix the problem?

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