Let me guess. Your doctors won't follow the rules and you are a hospital in trouble with CMS compliance. Or perhaps you're a doctor at risk for losing your hospital privileges because your physician documentation is placing your hospital at risk for losing their accreditation status. Whatever the case may be, physician compliance with ridiculous documentation rules and regulations will always be a difficult road to pave.
At Happy's hospital, the current CMS compliance guideline hysteria revolves around two issues. I put the first to rest with an explanation about physician food and drink at the nurses station. The second issue, the signing, dating and timing of verbal orders within 24 hours, is a mystery to me. Not only has the order already been dated and time and signed by the nurse, and verified by read back, but CMS compliance guidelines require physician documentation to counter sign, redate and retime the order within 24 hours. I can assure you that in my last seven years of clinical hospitalist medicine, I have never seen a single case of patient harm due to the lack of a counter signature, redate and resign in 24 hours. If you tell me the lack of a counter signature within 24 hours impairs the quality outcomes of my patients, I will immediately fight for universal acceptance. Unfortunately, 99.9999999% of all orders given will have been completed by 24 hours. The clinical relevance of this 24 hour compliance guideline is a mystery to me.
What this policy does is take away precious time from understaffed nurses who are now required to hunt down doctors who may be in doing surgery or who may be in clinic or who may be sleeping to sign off an order that has already been implemented. Nurses, in addition to all their other stretched duties, must now play baby sitter to physician documentation and physician compliance requirements to meet the ridiculously obtuse CMS compliance guidelines.
With such an effort being made to meet the standards of physician compliance and documentation at Happy's hospital, I learned the other day, what the fruits of these labors have brought. A labor intensive one month audit has discovered just how much physician documentation has improved and just how far Happy's physicians have to go before CMS compliance guidelines have been met.
I'm all about quality care. So it came with great excitement when our internal audit discovered a 10% improvement in the 24 hour signature requirement. With such a rigorous effort being placed on physician documentation and compliance I had to wonder how many lives Happy's hospital physicians have saved by improving their 24 hour counter signature rate by 10%. With tens of thousands, perhaps hundreds of thousands, maybe even millions of orders in that one month period, I would expect a dramatic improvement in mortality and complication data for that month. Was there a statistical reduction in mortality or complications?