Hospital Medical Transcription

Hospital MT, 1996 / Comparison of Hospital and Office MT / Back to Free Stuff
2/97, from Nancy,
I want to offer recognition here to the administration and staff at Ashland Community Hospital in Oregon. The transcription room is NOT in a basement. It is in the center of the hospital and has a window overlooking the garden/lawn area. The administration just remodeled the entire room with beautiful modular furniture and excellent lighting and has networked the computers so you can share all the macros, etc. The room space is very limited, but the set up is just about the best I have seen.

Transcription is recognized as a legitimate keystone function of medical records. The MDs work well with the transcriptionists and actually stop in to say hello to the MTs.

I am only on-call there now and it really took my breath away when first I stopped in and saw the new setup. ACH deserves a real pat on the back, IMHO.

2/97, from Becky:
We use MedWord by Lanier. The "normals" are entered by the supervisor at the hospital (who, BTW, is not an MT). You ask her to put it there, it's there - correct or not. Here are a few examples that I marked incorrect when I did a quality check for the supervisor last year:

"the patient was given a prescription for by mouth Biaxin"
"It was decided to keep him nothing by mouth for now"
"Darvocet-N 100 as needed pain"
"the laparoscopic was advanced into the esophagus"

There were literally scores of others - all caused by using the "normals" . It is also a common practice in our office (NOT BY ME) to type "the patient was prescribed Darvocet 100 milligrams by mouth three times per day" "he was given 2 cubic centimeters of"

Now I'm a stickler for perfection, and I know it. I'm also sometimes wrong, though I don't act like it right now :). My point is that there is one focus in our department: more characters = more lines = more money - PERIOD. There is no discussion about terminology, usage, grammar, and no editing done. There are no more quality checks, either, because there was too much hell raised by people who didn't meet their 99% accuracy quota over stuff like I displayed above.

I say an error is an error. I look at all these posts on smt, people who care about their work, and I'm thinking that the difference may be ICs who are held accountable for what they do versus MTs who get paid no matter how crappy their work is. But there are hospital MTs here who care about their work too. What is the DEAL with our hospital?

I know - this is none of my business, as long as I produce work of good quality and make my money. I keep telling myself this, too. But I wonder if the doctors who complain about this stuff (all the way to Medical Care Appraisal Committee) look at the initials and know that we're not all inept?

2/97, from Kay:
I don't think it's just your hospital. The last hospital I worked for as an IC also had a MR department headed by a person who not only was NOT a CMT, but had never transcribed and could not type. ( However, that did not keep her from quoting AAMT incorrectly whenever it was convenient for her). The bottom line is money. Period - end of sentence. This hospital hired transcriptionists who did not know what the most basic medical terminology was and thus, could not transcribe the physicians and thus, the motto became: "Just leave it blank." The point was this: GET THE WORK OFF OF THE SYSTEM ANYWAY YOU CAN. There was no quality control, no continuing education. Everybody was too busy trying to get the work off of the system to care. This does not mean that the transcriptionist does not care. It is just the situation and pressure that he/she is forced to work under. They give incentive for increased production but no "incentive" for error-free work. Why? Because no one checks it! So, poor quality hospital transcription becomes its own self-fulfilling prophecy.

In the age of cost cutting, it seems the advertising campaign for "this" particular hospital outweighed the need for hiring, paying and training professional quality transcriptionists. I won't even get into where I feel AAMT's responsibility lies in all of this mess.

2/97, from Mary:
I worked in a hospital where the quality was poor. Fast lines with sloppiness, padding and lots of blanks are a risky business that makes people feel uneasy and cheap. The pressure to produce is demoralizing as well; the two extremes of pushing and permissiveness is crazy making.

Here's a suggestion: Get the MTs to submit a proposal for a department style guide. That is what changed our hospital transcription unit a whole lot for the better, along with morale building at the grassroots level among the MTs. Of course, this can cause divisions between MTs, so it has to be done with kindness and encouragement to grow rather than beating people down into perfectionism. Another suggestion is to persuade your supervisor to let you work from home where you can at perhaps work with your own software. My last suggestion is to start applying to companies that have high standards with style guides and no padding allowed. You will feel so much better about your work and yourself, and you can make better money as well!

2/97, from Janie:
It's been approximately 4 years since I worked in a hospital medical records department so I don't know if they are still employing these methods, but it WAS one of the hospitals that DID care about quality. Twice yearly, the supervisor (and she was an MT) would randomly pull 10-13 of our documents and edit them for quality, style, etc. Some items were counted as errors (e.g. incorrect or nonexistent term, capitalizing a generic med.) while others such as style errors (e.g. putting commas in the incorrect place) were brought to the attention of the MT but NOT counted as errors. We were given an accuracy rating that probably figured in our raises and, later, figured in our incentive program (we had to meet 98% accuracy in order to obtain the incentive pay for production). So not ALL hospitals are out to jack up production at the cost of quality. I learned the most from my time in this department. The QA review was an excellent learning/teaching tool, and I only wish other hospitals/services would employ this. I think occasionally some MTs may look at it as punitive ("oh no, they're going over my reports with a fine tooth comb"), but I felt it was not in that light. When we were called in to discuss the QA of our reports, it was a two-sided conversation, so you felt as if you had some input into the review.
From Becky again:
The MTs in my department do not care about any of this, with the exception of the one person that I hired straight from school (over the objections of everybody involved - I felt she had that "extra chip in her brain" and she did. She's been there 8 years now and is really good. My approach to quality checking when it was my job: The MTs no longer lost $ for errors, as before; I tried to encourage discussion and learning, and published a (VERY anonymous) list of common errors, their corrections, with sources and the reasons they were wrong. It all worked out so well until I stepped down. The issue is money.

I do work from home. I was the pioneer and worked at home for about a year or two before we bought our software and sent the rest of the MTs home. We are required to use their software because we print at the hospital and all the reports have to be on the data base so they can be accessed. We really "have it good" as far as that goes.

I'm going to be forced to apply to a service, in spite of my love for the hospital where I've been employed for 15 years, and all my vacation, benefits, friends, and the decent name I've made for myself. I just didn't want to do this.

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