The Employment of Searchable PDF Files Vastly Facilitates the Completion of Respiratory Care Departments' Billing Audits

Abstract

Background:

I was asked to undertake an audit to determine: 1) the number of patients for whom hand-held nebulizer (HHN) therapy was initiated within a given month in our 348-bed acute-care hospital; and 2) the mean number of HHN treatments administered to each patient.

Methods:

Our hospital’s accounting department employed a commercial electronic health record system (Sunrise Eclipsys, Atlanta, GA) which generated billing data as comma-delimited text files. In every row of such printouts, each therapeutic modality performed was assigned a unique numeric code. Each HHN initial was identified as an 8-digit code, while each HHN subsequent corresponded to a different code. I feared that I would need to sift through literally thousands of lines of computer code to ascertain the number of initial and subsequent HHN treatments that occurred over the course of the entire month. This would be an extremely tedious and time-consuming task and would elicit numerous errors. But I had already acquired considerable experience with Acrobat word processing software (Adobe, San Jose, CA). Acrobat’s portable document format (or PDF) files display the attribute of searchability: they identify any text/numeric string appearing within a voluminous document and generate a list of the location and frequency of that string. The accounting department readily agreed to convert the comma-delimited text files to PDF files, enabling me to generate a list of each initial HHN and every subsequent HHN at the stroke of a key. We could be confident that the flawless reliability of this computer process succeeded in capturing every instance in which the numeric codes of interest were generated.

Results:

Initially, we estimated that HHN therapy was administered to 300 patients per month, and that the average number of HHN procedures for each patient was approximately 12. When the audit was completed, we found that HHN therapy was initiated in 509 patients. On the other hand, our estimate of the number of HHN treatments received by each patient was found to be fairly accurate: 15.2 treatments.

Conclusions:

Audits are often necessary in order to formulate sound reporting, staffing, and budgetary decisions. The reliability of such decisions necessitates audits be comprehensive, authoritative, and accurate. The availability of software that exploits the power of the digital computer can transform onerous, laborious, and error-prone operations to rapid and reliable analyses.