Documentation and Data Collection Resources

Teaming Up and Cleaning Up...for Accurate Data Reporting

The Health Services Advisory Group (HSAG) Outpatient Quality Reporting Quality Innovation Network (OQR QIN) has designed this kit for you in response to common data-abstraction obstacles shared by hospitals nationally. HSAG is excited to provide you with these documentation and abstraction Clean-Up tools, developed through a culture of sharing and driven by our commitment to your success in the OQR program.

With increasing focus on data measurement and process of care improvement, the creation and abstraction of accurate information has become vital. The tools in this kit are designed to help identify and clean-up missed opportunities in documentation and abstraction, improving the accuracy of the data and making it more apparent if true process deficiencies exist.

• The Documentation Essentials cards, designed specifically for Emergency Department (ED) nurses, describe the key information fundamental to accurately measure ED processes and outcomes.
  • OP–4 Aspirin Received and OP–5 Time to ECG pocket card
  • OP–21 Pain Management pocket card
  • OP–23 Head CT/MRI Interpretation pocket card

• The Let’s Measure Up for Quality! document is designed for data abstractors to provide them with the most current national averages against which facility values can be measured.  When facility data is worse than national average, this abstractor is encouraged to pause for a second look. This document provides measure element prompts, available resources, and support contact information. This document will be updated quarterly.

Combined, these tools aim to support your efforts by improving the accuracy of reported process data. It is our pleasure to work with you!