All Entries Tagged With: "nurse"

CDI at Bat

The outlook wasn’t brilliant for the CDI that day:
The chart stood unattended, with one hour left to stay,

Even the best documentation specialists strike out once in a while.

And then when Dr. Cooney didn’t chart, and Dr. Barrow did no more,
A pall- like silence fell upon the patrons of the floor.

A straggling few got up to go in deep despair. The rest
Clung to the hope which springs eternal in the breast:
They thought, “If only Dr. Casey could get a whack at that,
We’d put up even money now, with Dr. Casey at the bat.”

There was ease in Dr. Casey’s manner as he stepped into his place:
There was pride in Dr. Casey’s bearing and a smile lit Dr. Casey’s face.
And when, responding to the query, he lightly doffed his hat,
No stranger on the ward could doubt ‘twas Dr. Casey at the bat.

The usual sneer had fled from Dr. Casey’s lips; his teeth clenched in rage:
He pounded with cruel violence his pen upon the page.
And now the nurse she holds the query, and now she lets it go,
And now the air is shattered by the force of Dr. Casey’s NO!

Oh, somewhere in this favored land the sun is shining bright,
The band is playing somewhere, and hearts are light,
And somewhere men are laughing and little children shout;
But there is no joy at the hospital – mighty Dr. Casey had struck out.

To lead or not to lead: Forming compliant queries

“Whether tis nobler in the mind to suffer
the sling of outrageous fortune,
or to take arms against a sea of troubles,
and by opposing, end them.”

~Hamlet, Act III, Scene I

Shakespear as CDI? Hummm. . .

I truly think that Shakespeare was a frustrated CDI nurse.

I was not fortunate enough to attend the annual ACDIS convention in Las Vegas, but my colleagues let me read through their books. The AHIMA practice brief baffled me when it was introduced in 2008. Has anyone read this carefully? There is an interesting quote from a CMS memorandum issued on October 11, 2001:

“CMS Position is that a query form should not be leading, and it should not introduce new information not otherwise contained in the medical record.”

If a physician documents that a patient has hemoglobin of 5, how can anyone query for anemia if use of the word anemia is prohibited? Furthermore, query forms should not have the name of the condition, diagnosis, or procedure unless such was already listed in the medical record.

Any nurse who works in a hospital intensive care unit has seen the vent setting carefully listed on the record with no mention of the patient being intubated or why. How can a CDI clarify acute respiratory failure and the intubation procedure without mention of the vent, the endotracheal tube or the possible causative diagnosis?

I can understand phrasing the query in a question format (after all I grew up watching Jeopardy): “What is the underlying diagnosis?” I can also understand the rationale for not phrasing the question in a “Yes” or “No” manner. I would not want a physician to say “yes” and then not document anything on the progress note. This is self explanatory. What I have a hard time understanding is what appears to be the systematic torture of physicians who are exposed to ambiguous clarification forms.

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Consider CDI time management techniques

“E-mail eats the day away.” Sounds like a play on the ‘ole “apple a day” routine, doesn’t it? It’s actually an PR piece touting a new software that sorts and prioritizes your e-mail. Imagine if  automatic e-mail management saved you hours every day. I’ve seen some pretty disorganized e-mail in my day. One co-worker had more than 600 messages in her inbox at one time. She wondered why her e-mail wouldn’t work.

That press release got me thinking about how clinical documentation improvement (CDI) specialists manage to juggle their responsibilities and how they can effectively make the case for CDI to physicians whose time management techniques are already being tested.

Physicians often say their biggest concern about providing high quality documentation in the patient record is the amount of additional time they think it will take, according to Ruthann Russo, PHd, JD, MPH, RHIT, partner in the law firm Russo and Russo, LLP, in Bethleham, PA.

Time flies so try to make the most of it.

In her handbook Time Management for Clinical Documentation, Russo pools a variety of sources to show how various stakeholders’ demands affect a physician’s time management capabilities. For example, insurance companys frequently assume that a primary care visit takes a physician a mere 16 minutes. When micro-management of that caliber can affect your fiscal well being, imagine the time management stress that must result.

“Supporting your physicians in the time management process can result in better clinical documentation practices,” Russo writes.

Here are some time management tips you can either share with your physicians or keep to use yourself:

• Prioritize
• Plan your day
• Plan for breaks and take them
• Handle each piece of paper (or e-mail) only once
• Make decisions, don’t procrastinate
• Block out specific time to respond to phone calls
• If there’s a task you dread, do it right away and get it out of the way

Physician support for CDI programs suffers when they worry about how additional documentation requirements could encroach on their already limited available time, Russo says. So, be open and honest with physicians. Talk about their time concerns and be realistic about how much time your additional interactions may take. Initial physician training sessions are a perfect time to raise these concerns and share some of your own time management techniques.

Effective communication equals a CDI nurses’ strength

Good communication is a key attribute of a successful clinical documentation improvement specialist (CDIS). The CDIS must be able to function in a variety of different settings. These include the CDIS office, the patient care unit, and presenting at rounds. All require flexibility, quick thinking, and a sound knowledge of clinical documentation policies.

Many hospitals have been reluctant to use nurses in the role of CDIS, adhering to the belief that nurses cannot be retrained to think like coders. Why would anyone want them to? Nurses bring their own qualities and strengths to the job.

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Breaking down sterotypes the CDI way

Those who have their eyes and ears open these days can’t help but see a shift at play. Monday was Martin Luther King Jr. Day. Tuesday, we inaugurated the 44th President of the United States—and celebrated the first African American picked for the post.

So what better time to reexamine the stereotypes that most afflict the CDI profession—the preconceived notions about the roles and responsibilities of CDI specialists. There’s been lots of talk about who makes the best CDI professional—coders or nurses, case managers or HIM professionals. Similarly, there’s plenty of discussion about how to overcome the challenges of the “difficult” physician.

ACDIS advisors have tackled some of these concerns in CDI Journal articles, ACDIS Blog posts, and CDI Strategies snippits. For instance, check out this article from the CDI Journal regarding how to bridge the gap between coders CDI programs in the January 2008 issue, or this article by Lynne Spryszak, RN, about how to work with ancillary departments at your facility, or this piece regarding the role of physician advisers.

Now is the time to take a second look at our own stereotypes and break away from preconceived notions of how we expect people to think or work or act. This shift may just open the door to new possibilities.