Presenter Status
Resident/Psychology Intern
Abstract Type
QI Project
Primary Mentor or Principal Investigator
Nicholas Clark
Presentation Type
Oral Presentation
Start Date
11-5-2026 12:00 PM
End Date
11-5-2026 12:15 PM
Abstract Text
Problem Statement/Question:
Appropriate documentation of medical diagnoses is crucial to hospital billing and can limit insurance contention of medical treatments. Incorrect or vague documentation of diagnostic codes can decrease hospital reimbursement, and post-discharge queries can cause unnecessary time burdens on physicians. Pneumonia diagnoses account for almost 25% of all queries at Children's Mercy Hospital, mostly due to failure to include specific details such as causal organism or location. From September 2023-2024 roughly 10% of pneumonia diagnoses required queries, of which 95% had suggested changes accepted, indicating that there is a need for improvement with initial documentation.
Background/Project Intent (Aim Statement):
We aim to reduce the percentage of overall pneumonia diagnoses requiring query on the general pediatrics hospital teams by 25% (23% to 17%) from October 2024 through February 2026.
Methods (include PDSA cycles):
After discussing the query process with a multidisciplinary team, we used multiple ongoing PDSA cycles to implement education about the query process, place printed reminders at computers, implement a dot phrase to prompt correct documentation, daily reminders at resident huddle, and teach interns on service. We collected data including total number of pneumonia diagnoses made by general inpatient pediatric teams, the number of these pneumonia diagnoses that required query, and the number of these queries that had agreements. Initial data collection was from November 2023 to September 2024 to identify the pre-intervention median. Our outcome metric was the percentage of queried pneumonia diagnoses. Our process metric was the number of queries sent to providers. Our balancing metric percent of provider agreement with biller queries
Results:
At the start of data collection, the median number of general inpatient pediatric teams' pneumonia diagnoses requiring query was 23%. This number was affected by changes in the hospital query process, which included the initiation of pre-discharge queries in February 2024. Prior to this, the median for November 2023-January 2024 was 13% and the median for February 2024-September 2024 was 31%.
After the initial intervention with education through didactic talks in October 2024, the median percentage of queries was 45%. The addition of a dot phrase and reminders at computers in April and May of 2025 showed a median query percentage of 33%. Combined with morning huddle reminders and teaching interns on inpatient service in July 2025, the median query percentage decreased to 18%.
With the decrease in query percentages, the median number of agreements with the queries also decreased from 92.6% pre-interventions to 85.71% post-interventions.
Conclusions:
Interventions were met with somewhat mixed results. Limitations included confounding factors, such as changes to the query process shortly after the first PDSA cycle, and surge viral season impacting the frequency of diagnosed pneumonia. The most effective interventions seemed to be creating persistent reminders at computer workstations and daily verbal reminders for residents. Future attempts to improve the query system would focus on using the EMR to remind providers upon documentation of a pneumonia diagnosis.
Improving Documentation of Pneumonia Diagnoses on General Pediatrics Inpatient Teams
Problem Statement/Question:
Appropriate documentation of medical diagnoses is crucial to hospital billing and can limit insurance contention of medical treatments. Incorrect or vague documentation of diagnostic codes can decrease hospital reimbursement, and post-discharge queries can cause unnecessary time burdens on physicians. Pneumonia diagnoses account for almost 25% of all queries at Children's Mercy Hospital, mostly due to failure to include specific details such as causal organism or location. From September 2023-2024 roughly 10% of pneumonia diagnoses required queries, of which 95% had suggested changes accepted, indicating that there is a need for improvement with initial documentation.
Background/Project Intent (Aim Statement):
We aim to reduce the percentage of overall pneumonia diagnoses requiring query on the general pediatrics hospital teams by 25% (23% to 17%) from October 2024 through February 2026.
Methods (include PDSA cycles):
After discussing the query process with a multidisciplinary team, we used multiple ongoing PDSA cycles to implement education about the query process, place printed reminders at computers, implement a dot phrase to prompt correct documentation, daily reminders at resident huddle, and teach interns on service. We collected data including total number of pneumonia diagnoses made by general inpatient pediatric teams, the number of these pneumonia diagnoses that required query, and the number of these queries that had agreements. Initial data collection was from November 2023 to September 2024 to identify the pre-intervention median. Our outcome metric was the percentage of queried pneumonia diagnoses. Our process metric was the number of queries sent to providers. Our balancing metric percent of provider agreement with biller queries
Results:
At the start of data collection, the median number of general inpatient pediatric teams' pneumonia diagnoses requiring query was 23%. This number was affected by changes in the hospital query process, which included the initiation of pre-discharge queries in February 2024. Prior to this, the median for November 2023-January 2024 was 13% and the median for February 2024-September 2024 was 31%.
After the initial intervention with education through didactic talks in October 2024, the median percentage of queries was 45%. The addition of a dot phrase and reminders at computers in April and May of 2025 showed a median query percentage of 33%. Combined with morning huddle reminders and teaching interns on inpatient service in July 2025, the median query percentage decreased to 18%.
With the decrease in query percentages, the median number of agreements with the queries also decreased from 92.6% pre-interventions to 85.71% post-interventions.
Conclusions:
Interventions were met with somewhat mixed results. Limitations included confounding factors, such as changes to the query process shortly after the first PDSA cycle, and surge viral season impacting the frequency of diagnosed pneumonia. The most effective interventions seemed to be creating persistent reminders at computer workstations and daily verbal reminders for residents. Future attempts to improve the query system would focus on using the EMR to remind providers upon documentation of a pneumonia diagnosis.
