Some query questions

angelisa.romanello

Hello everyone,
I have been searching the ACDIS website to see if I can reveal information related to the percentage of queries for a given program. Our program is 5 years old and we have 3 CDI nurses for 750 beds minus peds and OB. I believe a seasoned program should not have to query 46% of the charts just to meet metrics.

We have about a 26-30% query rate.

Any thoughts from the group?
Thank you

Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement Specialist
Quality Department
CJW Chippenham Campus
Angelisa.Romanello@hcahealthcare.com
804-228-6527

robert.hodges2

This was brought up in a discussion a few weeks ago. I know that as my
program has gone forward the query rate has dropped because
documentation is getting better. I still do around 20-30% depending on
the month, but that's less than when I started.

Robert

Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov


"Patriotism is easy to understand in America; it means looking out for
yourself by looking out for your country" Calvin Coolidge

angelisa.romanello

Thank you Robert

Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement Specialist
Quality Department
CJW Chippenham Campus
Angelisa.Romanello@hcahealthcare.com
804-228-6527

sharon.cole

Our query rate has stayed the same. We write the same queries over and over, and have provided education in several different formats, to the point that it's quite obvious they know what they should/could be doing, but just refuse. If we don't query, they don't write it. We constantly have to query for CHF. It makes me extremely frustrated to read:
Day 1: Pt admitted in CHF, diurese.
Day 2: CHF improving, continue Bumex gtt.
Day 3: CHF now compensated. DC gtt.

Then when I query for decompensated, acute, exacerbated, etc - all I get is, "no, that's just chronic CHF". It's like a weird dance in which they try to sidestep saying the verbiage that will make a difference to their LOS, SOI/ROM (and yes, the hospital's bottom line).

I revised my query to include "Pt's CHF requiring IV diuretics and is unable to be managed at home or at CHF clinic, please indicate/document if you are treating any decompensation, exacerbation, or other aspect of this chronic condition."

I sometimes get the verbiage with that statement. But not always:/
And I'll stop my whining now:)


Sharon Cole, RN, CCDS
CDI Specialist Team Leader
Providence Health Center
254.751.4256
Sharon.cole@phn-waco.org

prector

How much one on one education and interaction do have with your hospitalists/Pa's/ nurse practitioners? Our approach has always been " we are here to assist you" you don't have to agree with us but please clarify your documentation, treatment rendered-ordered with a corresponding diagnosis. We started with our hospitalists and had decreased out query rates by 25% from 1st qtr to 4th qtr 2012. We now have doctors calling us to ask questions!

Paula Rector, RHIT, CCDS

catladyrn

Sharon,

Love your ingenuity, but your verbiage feels just a wee bit leading to me. I might verbalize that to a physician, but I'd be afraid to put it as an integral part of the query.

I'd put it in the supporting documentation, though. Along with some education that non-exacerbated chronic conditions are not usually appropriate reasons for inpatient admissions. It's even more frustrating because the physical findings and the treatment will probably meet inpatient criteria, but without the actual diagnosis, the chart is at risk.

Renee

Linda Renee Brown, RN, CCDS, CDIP, CCS

sharon.cole

I’ve given formal presentations to the groups about how accurate and complete documentation helps support medical necessity, LOS, and SOI/ROM. We all have 1:1 education/verbal discussions on the floors when they come looking for their charts. Twice a week they want the top 5 queries and what they are about so I send this to them. I’ve given them Dr Gold’s booklet, Dr Bensen’s pocket cards, articles from several physicians who write for ACDIS, “Minute for the medical staff” articles, Hospitalist’s journals, etc. Now admin has written into their contract they have to answer (not agree with, just give any old answer) to our queries. Last month they didn’t meet admin’s goal, now the docs have insisted that I have to send an email at the end of the day with all queries written to them today and anything not answered from yesterday, etc.
They can have a conversation with you, tell you of course this is acute, then turn around pick up the chart and then document chronic. If it wasn’t so frustrating, it would be funny. I’ve told them that with ICD-10 we are going to need even more information, including indicating the severity of conditions. For instance, respiratory failure will default to chronic if not specified as acute. They keep saying this is a game, they don’t care, and they are not going to play. I’ve had discussions about how documentation will one of these days affect their billing and that already physician and hospital billing is being compared. We can’t even get op reports and DC summaries for several months sometimes, so what do you do?
I do have some docs that are great and really try and who pick up the education really easily, but then we have those who are just difficult – who then rub off on the ones who are doing a good job. It’s anarchy☺

Sharon Cole, RN, CCDS
CDI Specialist Team Leader
Providence Health Center
254.751.4256
Sharon.cole@phn-waco.org

prector

Our queries are also a deficiency. They have 14 days from issue or it becomes delinquent.

Paula Rector, RHIT, CCDS