|The accuracy of HIPE coded data in patients with acute exacerbations of COPD: a quality improvement project
|E. Cronin B Cushen
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|The number of cases of patients admitted to Irish hospitals with Chronic Obstructive Pulmonary Disease (COPD) as their principal diagnosis has increased over the last 10 years from 10,996 in 2010 to 16,184 in 2019 (1).
A retrospective chart review was carried out on 22 patients who died in 2019 with a HIPE coded admission diagnosis of an acute exacerbation of COPD (AECOPD). Data were collected and a comparison was made between the admitting diagnosis as documented by the NCHD, and the admitting diagnosis as documented by the consultant.
In 50% of cases (11/22) the consultant diagnosis was not of an AECOPD. In 6/11 of these cases, while the admitting NCHD had initially documented the diagnosis as an AECOPD, on consultant review an alternative diagnosis was documented (e.g., pneumonia). In the other 5/11 cases, COPD was not mentioned as the reason for admission, yet was HIPE coded as such. Interestingly, in 4 of these 5 cases the patient had a diagnosis of type two respiratory failure.
We conclude that reliance on the admitting NCHD documentation for HIPE coding may lead to incorrect data capture. The lack of an objective marker of a COPD exacerbation means patients are erroneously labelled and treated as an exacerbation when alternate coexistent pathology is responsible.