CDS assignments
I really appreciate all the insight all of you have given me so far. Our
CDS group has always rotated every three months through all of the
service lines for over 5 years now. We have a new manager and we are
going to start staying in one place.
For those of you who stay in one area I have a few questions?
1. How do you hand off cases? Who gets credit for the query and or the
case?
2. What is the process if any of the CDS involved in the case
disagrees with any part of the received case?
Any successes, learning opportunities you would be willing to share.
Thanks in advance to all that reply.
Mary A Hosler, RN, MSN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug."- Samuel "Mark
Twain" Clemens
Comments
We review by service line and we follow our patients their entire stay; even if they change services. I personally think this is the easiest way. I would find it personally frustrating to sign off cases and not get to see them through to the end (though there aren't many I re-review that many times) and I also think it helps to have the same set of CDS eyes on the case as our patients will often have several different attendings during their stay if they are here for any length of time. We had been rotating every 3 months as well but I have now been with the same services for 7 months due to staffing issues. I think it helps to build relationships with the MDs to not rotate every 3 months. That being said I am not sure what we will do after we train our new staff and get back up to our full quota of staff.
Hope that helps,
Cindy
Cindy Goewey RN, BSN, CCDS
Clinical Documentation Specialist
Dartmouth-Hitchcock Medical Center
1 Medical Center Dr
Lebanon, NH 03756
Phone 603-653-6814
Pager 4741
We are unit based, so if a patient moves from one unit to another, the person based on that unit completes the re-review. Since we use the 3M system the person who initiated the query will get credit for it when it is answered.
However, our end of the month numbers are reported as a group/facility. I do not report out individual numbers. We try to keep this as a team effort and not an individual effort. In the long term, our patients are moved so much that it seems to work out that each CDS ends up picking up for each other on a regular basis. I do monitor how many queries each person is leaving and how many reviews they are doing on a daily basis.
We have had some cases where one CDS differs with another. We ask that a dialogue take place and leave room open for interpretation. Sometimes, if you talk it out, you end up with a greater understanding of what the person who initiated the query was thinking. Sometimes, we have to agree to disagree and move on, but those times are rare.
I hope that helps a little.
Lisa
Lisa Romanello,RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement Specialist
CJW Medical Center
Quality and Compliance
804-228-6527
We are unit based at my facility.
When a patient is transferred the CDS assigned to the new unit picks up the case.
The CDS who initiates the query gets credit for the query.
If more than one CDS reviews a chart - both get credit for their work.
As someone else already stated, we are a team and try to take a team approach.
The goal is to review all cases assigned to us and to complete them to the best of our abilities.
If there is an issue with a query that was placed or a DRG assignment we will discuss it and come to an agreement.
Thanks, Debby
Deborah A Dallen,RN, CCDS
Albert Einstein Medical Center
Phila PA 19141
Clinical Documentation Coordinator
Health Information Management
215-456-8902
Now with essentially all EHR, cases are initiated through a focus on Service Line (though for operational reasons, there are elements of unit also).
Once a CDS initiates a case, it is their's until discharge.
Depending on the state of your EHR & size of hospital, I'd encourage following a case until discharge.
When we handed cases off, queried cases were kept in the name of the original CDS and the case was checked by the CDS on the new unit for any significant change. Queried cases were not handed off until the query was resolved, sometimes the first CDS would continue to follow until discharge.
For cases without query, the receiving CDS was free to change as they saw fit (since the case was going to be in their name if followed until discharge). There would be conversations for some cases to help understand the total picture and the understanding of the case.
There is a draw back in not rotating -- folks get a bit TOO comfortable with a particular clinical area and sometimes end up not wanting to cross cover. Surgical cases were more intimidating for those mostly covering medical. Flip side -- better opportunity to build relationships with a core group of physicians.
Don
I agree that there may be an issue with being too comfortable. However, we always cross cover for vacations, days off, sick time, etc. So we are exposed to the other areas enough that we do have a comfort level with every unit within the hospital.
Being unit based, we do have the chance to build those relationships with our physicians and, as we cross cover, the physicians in other areas become more familiar with us and vice versa. We also do our presentations and education sessions as a group - so they see us as working together as a group.
Debby
Deborah A Dallen,RN, CCDS
Albert Einstein Medical Center
Phila PA 19141
Clinical Documentation Coordinator
Health Information Management
215-456-8902
How many CDI Specialists are on your team?
Linda Haynes
lhaynes@lhs.org
Deb
Deborah A Dallen,RN, CCDS
Albert Einstein Medical Center
Phila PA 19141
Clinical Documentation Coordinator
Health Information Management
215-456-8902