CDI in the ED

Unknown
in CDI Talk Archive
Hi,
I know that there are some programs with CDI in the ED.
What is your role in the ED? Are you looking at documentation to ensure it provides rationale and medical decision-making for medical necessity? We are getting gobs of denials for Medical necessity and I am wondering if CDI could help.
Thank you in advance.

Comments

  • Unknown
    edited May 2016
    CDI can greatly assist in the Emergency Room, reviewing clinical documentation for proper reflection and capture of patient true severity of illness to support nursing and physician interventions as well as physician thought processes, clinical judgment and medical decision making. This by definition requires a CDI to incorporate thought processes similiar to that of a physician. Only when the CDIS can engage physicians in discussion of these thought processes from a clinical perspective will CDI become a valuable asset to improving documentation in the ER. Traditonally, CDI thought processes incorporate securement of diagnoses in the record, something that will not further capture of medical necessity in the ER.

    Just some food for thought for everyone out there to contemplate.
  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited May 2016
    We don't currently review in the ED.
    Depending on how robust your UR activities are, and how front end, CDI can certainly make a significant impact on medical necessity. A partnership between CDI & UR/CM may be also be very fruitful. Do be careful to not blend roles.

    You may want to take a look at:
    * the Journal, July 2011 "CDI efforts in the ED need not be traumatic"
    * CDI Week Q&A 2011: Expansion of CDI into Outpatient
    * Take a look back through the ACDIS blog, there are several posts that might be helpful. One of the bloggers that addresses these kinds of things is Glenn Krauss -- if you click on the bloggers name in the right column, you should pull up all of their posts.

    Don
  • Unknown
    edited May 2016
    Thank you Don. Great suggestions. That is one of my main concerns (blending of roles) and where I fear our MD advisor is pushing us. (She is also MD advisor to UM). I do think CDI is desperately needed in the ED. We are nearing a 100% denial rate on our 1st RAC audit due to medical necessity.
    Our CDI team is not involved in the RAC process as this point in time, but I did sneak a peek at a couple of charts. From what I saw, the patients could have been inpatient admissions had the physicians used their words to express their medical decision-making and rationale for the need to admit. As CDI, we can look past what is written on the page and see what could be written. The MDs don't even know they need to do this so our job would be to inform them. Of course, in a non-leading and compliant manner:)
    I will check out these resources. Thanks again.

    -Jane
  • mdomineseymdominesey
    edited May 2016
    I attend the UR meetings at my hospital to contribute what I can. It is amazing how many cases get lost to audits because of a lack of medical necessity being documented. Also, many cases get recategorized to OBS and OBS Other because of the lack of medical decision making in the chart. I help the UR Case Management folks and their Physician Advisor with suggestions for the type of language the physicians can use to describe the patient's condition in order to capture sufficient severity and risk. The Milliman and Interqual categories do not align with what we know to be clinical diagnoses, so there is much opportunity for us CDIs to assist. But Don's warning is appropriate - we should be wary of the mixing of the roles.

    Mark



    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    http://www.sibley.org
    mdominesey@sibley.org
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