Narrative vs entire PCR

DrParasite

The fire extinguisher is not just for show
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My statement was, the narrative is the most important part of your patient care report. Full stop.
Fair statement. Ever use EMS charts at your agency? they don't have a narrative. anywhere. at all. Period. So if something is that important, I would think that a popular EMS charting system would have included it in it's software package.
Some of you choose not to believe that, which is fine. Your agencies may not believe that the narrative is the most important component of a patient care report, and that is also fine.
I know this wasn't your intent, but when you make that statement, and then back it up with your title as QI officer, you are pretty much saying everyone who disagrees with you is wrong, and you are right, using your title as backing up your claim.

Personally, I think your wrong, and I would ask anyone who says "the narrative is the most important part of the PCR" why aren't they looking at the entire PCR? No one section is more important, and each section by itself doesn't paint the entire picture.

Electronic charting has changed the way we document, but some old timers continue to hold onto the classic concept that "everything needs to go in the narrative!!!" We have more space to include information away (since a text field can hold unlimited information, compared to the old 3x5 box on the paper forms), and we can include more text boxes where you can put information. Personally, I love documenting in the flowchart. This is what I did, when I did it, what happened after I gave them something. you can timeline much better than with a story.

Now if I am working for your agency, will you be pulling me into your office because my narratives aren't what you want? probably. And any information you ask that isn't in the narrative, my first response is "your right, but if you look up a little bit, you will see the information you are looking for in this check box, with the required information." If it's not there, and it's medically relevant to this patient, and it's not documented anywhere else in the PCR, we might agree that you are correct that the information is missing.... but if it's not there, and not medically relevant to this patient, but would be relevant to other patients, then I am going to give you this example
I also never documented "the patient wasn't sexually assaulted in the back of the truck"; that doesn't mean that because I didn't documented it as a negative, that I molested them in the back of the truck.
See what I mean?

Your agency might want a huge narrative with a lot of duplication of information. And if I want to continue to work there, I will need to change my documentation habits to be what you want to see, or you will tell me to seek employment elsewhere. But just cause you are telling me that the agency way is a full narrative, doesn't mean it's required, or even the most important.

I will reiterate what I said previously:
speak to your billing company (or if your doing the billing internally, speak to your insurance company or some of your vendors) about what they want in the chart, and where, or hire a billing expert or consultant. If you want to know what needs to go where from a legal point of view, I would recommend you speak to your company's legal counsel.
I will also hypothesize that you can ask 3 different consultants for the best billing practices, and 3 different lawyers, and get 6 different opinions on what the best way to document would be. Just something else to ponder.
 

Tigger

Dodges Pucks
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I think everyone needs to get out if the mindset of "I like to do it this way" and "it's better for me if I use this tab".

Frankly, as the QI person, I don't care what you write in the note section of the assessments or other tabs, as long as you write a complete chronology of your patient encounter. It's not up to the individual provider to decide what goes in the chart. It's up to the provider to meet the documentation standard set by the service.

We retain legal counsel and a consultant to advise us of best practices from a reimbursement and legal standpoint. Those are the standards we follow.
We will transition to the entire service no longer documenting any assessment in the narrative in January. I am personally a fan of that as I believe it gives you structure to allow you to be more thorough. That is only one reason we are changing to this format, it will reduce duplication errors and allow for more time spent describing the actual events of the call. I believe you use ESO as well, so what from a QI perspective is lost here? Our QI people (it's an ancillary job so I am not saying they are the most well versed), are very pleased with this transition.
 

DesertMedic66

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If the narrative is the most important part of the whole chart, how does my flight agency (the biggest one in the nation) have a very robust QA/QI program, with a billing department and a legal department, with aggressive patient care guidelines operate with no narrative on our patient charts?
 

luke_31

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If the narrative is the most important part of the whole chart, how does my flight agency (the biggest one in the nation) have a very robust QA/QI program, with a billing department and a legal department, with aggressive patient care guidelines operate with no narrative on our patient charts?
Heresy. Burn the witch . Maybe, just maybe they have discovered the key... all that is written needs to only paint a picture of what was seen and done for the patient and a narrative is not the only answer.
 

DesertMedic66

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Heresy. Burn the witch . Maybe, just maybe they have discovered the key... all that is written needs to only paint a picture of what was seen and done for the patient and a narrative is not the only answer.
Exactly. If all you have is a hammer, everything looks like a nail.
 

RocketMedic

King of the Improbable
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Narrative provides context. Would not be thrilled to lose it. Check boxes and comments often lack nuance.
 

Remi

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Narrative provides context. Would not be thrilled to lose it. Check boxes and comments often lack nuance.
True. I wouldn't want to lose it either. But you can write a brief narrative that describes the scene and how things went down without repeating all the objective info already documented elsewhere, and without writing a novel. Again, the idea that "the more your write, the better", is patently false. It's just more old EMS dogma.
 

Akulahawk

EMT-P/ED RN
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As long as you can look at the report and determine the five "w's" of the call, and put it all in order from start to finish, it really doesn't matter what format you use. The important thing is to document accurately and completely enough so all that can be done and that you can therefore justify the care you provided. Remember, doing NOTHING is absolutely OK under the right circumstances and if you document it so that you can show that doing NOTHING was the appropriate care needed. Same for doing EVERYTHING. I don't double-chart whenever possible. It reduces the possibility that I mis-document a finding. If I charted that I found something on the right side and later forget and charted that I found it on the left... what else in my legal document might be wrong? I'm also a believer in charting (as much as practical) in real-time, or as close to it as possible. That way at the end of your time with the patient, you don't have much else to add to the chart and can close it out quickly.
 
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