From coding to clinical nurse specialist: how a review of coding practice enabled hysteroscopy nurse development
Clinical coding, the method by which departments are reimbursed for providing services to patients, is widely mispractised within the NHS. Improving clinical coding accuracy therefore offers an opportunity to increase departmental income, guide efficient resource allocation and enable staff development. The authors audited the clinical coding in outpatient hysteroscopy clinics at their institution and found that coding errors were both prevalent and correctable. By implementing simple changes in coding procedure, and without any additional administrative cost, they significantly improved coding accuracy and achieved an increase in total annual tariffs. Although not applicable in a block contract, this will become highly relevant in a restoration of the Payment by Results tariff system. Nurse development is a key objective of the NHS Long Term Plan but can be hindered by staff costs, which require departmental funding. In the authors' institution, improved clinical coding accuracy directly led to a departmental restructuring, funded the development of a new hysteroscopy nurse development and improved care delivery. Coding errors are not unique to the authors' trust, yet simple amendments led to meaningful changes. Therefore, careful auditing and implemented change are needed to raise national clinical coding standards, to enable clinical restructuring, staff development, and provide more efficient, patient-centred care.
Within the NHS, there is a growing disconnect between training health professionals and changing patient demands on the healthcare system. Therefore, as these demands increase and a shortage of medical doctors intensifies, a reshaping of the NHS is required (Wiseman, 2007; Woo et al, 2017). To this end, expanding the skills of registered health professionals and supporting the development of clinical nurse specialists are critical goals if the NHS is to meet the changing healthcare demands of the UK population (Imison, 2016). These objectives are outlined in the NHS Long Term Plan (NHS England/NHS Improvement, 2019). In this document, it is suggested that facilitating nurses to deliver advanced levels of practice is effective in meeting the ever-changing nature of patient needs while improving job satisfaction and workforce sustainability (NHS England/NHS Improvement, 2019).
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