Introduction:

Healthcare management requires tools to make decisions at the local and systemic level in healthcare providers, with quality and timely information, to optimise organisational processes.

Objective:

To identify, through analysis of the state of knowledge, the generation of errors in the creation of diagnosis-related groups that affect hospital financial management strategy.

Development:

487 research papers were reviewed, 54 of them identified processes of generation of the studied construct, with errors and evidenced in their materialization. These errors were grouped according to the original 3M model. Among those found were omissions in medical record documentation; poor quality in the minimum set of basic data; inaccuracies in diagnostic and procedure coding; insufficient grouping of diagnosis-related groups, variation in the casuistic index; deficiencies in team formation and audit processes; and discrepancies in the assignment of diagnosis-related groups. Recognising and addressing these errors will optimise efficiency in healthcare management.

Conclusions:

Errors were identified in the implementation of diagnosis-related groups, focusing on capture sub-processes, coding of clinical output and coding errors by healthcare staff. These types of omissions can contribute to key forms of performance evaluation of clinical care management, especially when this is associated with the billing structure and cost per patient in the current Chilean health system.

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