RE: ARF and census

sbeattysbeatty
edited May 2016 in CDI Talk Archive
Gail, I believe the answer to your question is relative to the process used. We are currently a completely paper process-worksheets with carbons that go into a "tickler" file on the date of the next planned review. We use Ingenix' DRG Expert to look up the MS-DRG for our working PDx. We look for documentation for every diagnosis being monitored, evaluated and/or treated, not just an MCC/CC. We then get the worksheets back post-discharge with the final PDx and we enter them into a database.

Based on this process, we generally have 15-30 reviews a day, depending on census, (We are licensed for 225 beds, avg census 100-125). (Our census is currently way down.) Of those reviews, we usually have 10-12 admits each day. The admissions usually take about 20 minutes. (We have a hybrid medical record, with all MD documentation paper, and all nursing, PT/OT/ST, RD, diagnostics electronic. A re-review takes about half the time if you do it every other day or so. If the SOI/ROM is 4/4, I may only look at the chart once a week, so that would take longer-maybe 20 minutes?

I hope this is helpful. We have 2 FTEs, RNs.

Comments

  • Unknown
    edited May 2016
    I have a question for all you CDI's out there. We've had insurance denials based on the fact that Sepsis was not documented in the chart until day 3-4 of admission. Patient met sepsis criteria on admission.
    How should I tackle getting better documentation to reveal that patient was septic on admission. Would it be enough to ask physician if it was present on admission? I am the only CDI for an 113 bed hospital and cannot always get to all charts within the first 1-2 of admission. I"m thinking this may be a physician education opportunity. Any thoughts or ideas would be appreciated. Thanks




  • Unknown
    edited May 2016
    Query for POA - there is no time limit so whenever you get to the chart and the clinical indicators are there - go for it.

    Charlene


  • Unknown
    edited May 2016
    This is definitely a physician education opportunity! We do query for
    documentation of "present on admission". We also ask for consistency in
    documentation throughout the chart, for example for them to write when
    sepsis has resolved. Of course we don't always get answers but we are
    persistent when we ask.

    Good luck.



    Gina Spatafore, RN

    Clinical Documentation Integrity Specialist

    Waterbury Hospital

    203 573 7647




  • cstukenbergcstukenberg
    edited May 2016
    I would give the corresponding clinical picture/diagnostics the patient had for sepsis and the time frames and then ask to have it clarified if POA


  • sbeattysbeatty
    edited May 2016
    What if you educated physicians to use the possible/probable/rule out convention to identify those very sick patients on admission who "after careful study" may be determined to be septic? I would also query for POA each time I saw sepsis noted after day of admission when meeting criteria on admission.

    For the insurance denials, I'd challenge them. Cite the source for your criteria for sepsis, then cite which of those specific criteria were present at admission. Follow that by quoting the definition of PDx with emphasis on the phrase "after careful study".

    But for the future, I'd query and save time taken for the appeal of the denials.


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