Countless terms are bandied about regarding strategies to assure medical record documentation meets accreditation and certification standards. Random sampling, concurrent review, and prevalence studies are just a few that come to mind. But have you ever heard of "choke points"?

Choke points are essentially stops in the care process where the patient's medical record is reviewed to assure that all pertinent information has been entered before the patient progresses to the next part of his or her care. If the medical record does not have all necessary documentation, then the patient does not progress until the deficiency is corrected.

For example, a patient in the pre-operative holding area would not be permitted to proceed to the operating room until there was confirmation in the medical record the patient had consented to the procedure, physician informed consent was obtained, an appropriate H&P had been performed, etc.

In another example, the patient would not be permitted to be discharged from PACU until there was confirmation in the medical record that an order for discharge had been obtained, the patient had met criteria, received necessary post-care instructions, etc.

The beauty of establishing choke points, is that if documentation is missing, the issue can usually be corrected before it can be cited by your accreditor or CMS. Establishing effective choke points requires buy-in with all the key stakeholders; leadership, medical staff, clinical staff, etc. If all don't agree to honor the process, then choke points rarely become an effective compliance strategy.

Obviously, choke points do not apply to urgent or emergent care. Necessary patient care should not be delayed. However, assuring timely documentation is in the record before the patient progresses to the next care process is an effective survey compliance tool.

Rick's clinical background is in critical care nursing with a focus in cardiovascular and trauma service lines. He has held both clinical and executive management level positions in Quality, Risk, Education, Infection Control, and Regulatory Compliance.

Rick is a regular speaker at numerous state and national conferences on the federal regulations and accreditation standards, and is host of CIHQ's popular monthly webinars addressing key compliance challenges in today's environment.

Rick is nationally certified in healthcare accreditation, and serves as Chair of the Board of Examiners for the Healthcare Accreditation Certification Program (HACP). Rick has a degree in Nursing with a Master's Degree in Health Services Administration.