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Dictation Best Practices
The Association for Healthcare Documentation Integrity (AHDI) is actively engaged in offering
our professional expertise to address the impact of problem dictation as it relates to
documentation errors and critical flaws affecting patient safety, the potential for sentinel
events, the effects on turnaround time, and the resulting increased cost.
The reasons for improved dictation throughout all healthcare facilities is compelling.
Incomplete or inaccurate documentation as a result of poor dictation habits leads to
patient-care errors and the potential for sentinel events. In addition, poor dictation
increases turn-around time and threatens timely delivery of care as well as delays
reimbursement. Not only is patient care affected, but unaddressed problematic dictation can
consume significantly more time and labor, thereby increasing overall documentation costs.
As the healthcare system rapidly moves toward adoption of EMRs and ultimately the EHR,
widespread attention has now turned toward speech recognition, yet vendors consistently cite
a low percentage of qualified users as a chief concern in assisting clients in adoption and
implementation of this technology.
The Dictation Best Practices Tool Kit is designed to assist facilities with the adoption
and implementation of policies and training practices that will promote high quality
dictation and ensure the best documentation outcomes. This kit includes Dictation Best
Practices: A Guide for Physicians, a self-running audiovisual presentation, as well as a
PowerPoint presentation with handouts for a live seminar. In addition, the kit includes the
rationale for promoting better dictation practices and Dictation 101, recommendations
for instructing dictators in good dictation habits. Visual aids include "Q" Cards,
a Tip Sheet, and a Documentation Workflow poster.
Sponsored By:
We would like to express our sincere appreciation to MedQuist for generously
sponsoring the production and distribution of the Dictation Best Practices Tool
Kit. AHDI is proud to work with MedQuist toward improved practices in
dictation.
Downloads
1. A Note from AHDI
2. How to Use This Kit
3. Dictation Best Practices Audiovisual Presentation
4. Dictation Best Practices PowerPoint Presentation
5. Presentation Handouts
6. Dictation Best Practices Rationale
7. Dictation 101
8. Sample Improvement Letter
9. Q Cards
10. Tip Sheet
11. Documentation Work Flow Poster
AHDI would like to track the adoption and implementation of these practice standards to
assess their efficacy. Please take the time to register your contact information with us
so that we can seek your feedback on the kit. For doing so, we will provide you with a
bonus document of sample facility policies and procedures related to dictation standards
for your facility.
Click here to register and download these bonus materials.
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