RE: re:Collaborative efforts between CDI and Case Management (And ED expansion)
Sara, I agree.
Dorie and Katie, I am going to answer both ED expansion and CM collaboration together if I may. The quickie version...
In November, CDI started working in the ED. At the time, the hospital was getting bombarded with denials for medical necessity. I wanted to understand why and thought that maybe CDI could help. I began this task by...
1st I met with all ED MDs on a 1-1 basis. I had the support of their director. While it was time-consuming, I thought it was the best way to connect with them and develop their buy-in. I met with them for 30 minutes each and explained the CMS inpatient vs. Outpatient/Obs. Admission rules and regulations as well as documentation of those big symptoms CP, Syncope, AMs, TIA. It was great for me to gain their varied perspectives. I also appreciated their looks of amazement and as we discussed how their words are coded. The most important piece of the puzzle to me--the physicians documenting in the record-- did not understand 1/3 of what we CDIs understand. Why? They had never heard that message. I am not suggesting no one had ever told them:). Mass presentations never hit home like a one-to-one conversation.
The ED MDs were on board.
2nd, we met with the CM team working in the ED. Again, I gained huge perspective learning how they work to assess and obtain admission criteria. And, again, I watched their faces come alive when I told them about CDI work flow. CM realized that having better documentation in the record and understanding how we come to DRG assignment could help them in their work. The CM nurses were on board.
3rd, we made tip sheets specific to inpatient vs. out-patient admission and documenting likely conditions rather than just s/s. We also imbedded ourselves in the ED. We were present to MDs and CM. CM loved the tips sheets. MDs liked to argue with them. But, that is good. I was happy to have the engagement. Discussion leads to mutual understanding.
It was a rocky road to start because MDs were confused as to who was doing what. I knew it would be a work in process (it still is!). But, I believe perseverance will prevail. The times are a changing and we so must our work flows.
I am happy to speak with anyone in greater detail about this process off cdi_talk. I think it is important.
-Jane
Dorie and Katie, I am going to answer both ED expansion and CM collaboration together if I may. The quickie version...
In November, CDI started working in the ED. At the time, the hospital was getting bombarded with denials for medical necessity. I wanted to understand why and thought that maybe CDI could help. I began this task by...
1st I met with all ED MDs on a 1-1 basis. I had the support of their director. While it was time-consuming, I thought it was the best way to connect with them and develop their buy-in. I met with them for 30 minutes each and explained the CMS inpatient vs. Outpatient/Obs. Admission rules and regulations as well as documentation of those big symptoms CP, Syncope, AMs, TIA. It was great for me to gain their varied perspectives. I also appreciated their looks of amazement and as we discussed how their words are coded. The most important piece of the puzzle to me--the physicians documenting in the record-- did not understand 1/3 of what we CDIs understand. Why? They had never heard that message. I am not suggesting no one had ever told them:). Mass presentations never hit home like a one-to-one conversation.
The ED MDs were on board.
2nd, we met with the CM team working in the ED. Again, I gained huge perspective learning how they work to assess and obtain admission criteria. And, again, I watched their faces come alive when I told them about CDI work flow. CM realized that having better documentation in the record and understanding how we come to DRG assignment could help them in their work. The CM nurses were on board.
3rd, we made tip sheets specific to inpatient vs. out-patient admission and documenting likely conditions rather than just s/s. We also imbedded ourselves in the ED. We were present to MDs and CM. CM loved the tips sheets. MDs liked to argue with them. But, that is good. I was happy to have the engagement. Discussion leads to mutual understanding.
It was a rocky road to start because MDs were confused as to who was doing what. I knew it would be a work in process (it still is!). But, I believe perseverance will prevail. The times are a changing and we so must our work flows.
I am happy to speak with anyone in greater detail about this process off cdi_talk. I think it is important.
-Jane