new CDS nurse

patwex

I am new to CDI and my hospital just started the new Documentation Improvement program. After just 2 months of being on the floors and reviewing charts, we are still off with the final codes . How does one cope with the learning curve and does anyone have some advice about how long it will take to get profficient in the postition and start seeing some evidence of our productivity?
My immediate supervisor and the coding supervisors are very supportive, but the administration is anxious to $ee re$ults

robert.hodges2

The learning curve can take a year or more just to be honest, and I still learn new things all the time and continue to work with providers on a daily basis to get precise diagnoses.

It sounds like one of your metrics is DRG match between your working DRG and the final coded DRG. I'm not sure if that's a good metric or not. I only use it for education since as my inpatient coder tells me, the working DRG is based on what is going on, but changes can occur in the discharge summary that will make changes to the final DRG. If you are working on a match, I would suggest talking over the mismatches with your coders and let them show you how they came to their conclusion.

The other suggestion I have is to see if you can push to attend as much training as you can. I was in the job for about a year before I went to the CDI Boot Camp and learned a lot there.

My best advice is when you have questions, post them here. There are a lot of smart folks around who have helped me out a lot!

Feel free to drop me a note anytime if you have questions. I won't guarantee I have the answer, but you never know.

Robert

Robert S. Hodges, BSN, MSN, RN
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
 
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens

NormaB

After two years we still have reconciliation problems. The key for us is to make sure we get back into that chart for further definition of our coding. That and close communication with the physicians.

twoods

I think Robert sums it up well. I have been in position only 5 months, have not attended boot camp. I have made the coders and HIM Director my best friends and go to people. They have taught me a lot. Good Luck.

Theresa Woods, RN, MSN
Jennings American Legion Hospital
1634 Elton Road
Jennings, La 70546
Phone: 337-616-7297
Fax: 337-616-7096
twoods@jalh.com
"Attitude is a little thing that makes a big difference." Winston Churchhill

Unknown

We did not even began monitoring our program for 3 months after the initiation. However, in looking back at the first 3 months, we were already making a difference. Our risk of mortality decreased; our case mix index increased. The capture rate of cc's and MCC's increased. The percentages of post discharge queries by the coders decreased. We started seeing the big difference in our program at about 6 months into it. Do you have a consultant? How mmany CDS to you have? Are they all RN's? I always give my new Doc Specialist 3-6 months for a learning curve. However, I also know that as Doc Specialist we are always learning because the coding rule and regulations and guidelines are changing with every year.

I hope this helps.

Juanita B. Seel, RN
Supervisor Documentation Management
Greenville Memorial Hospital
Greenville, SC
nurjbs@ghs.org

lspryszak

I agree with Robert (as usual) -- the learning curve is long! I tell all my students that it's at least 6 months before you feel like you have a clue, and a year before you feel somewhat confident in your PDx selections and working DRG assignments. No class, no matter how good, can cover every scenario -- remember, every chart is unique. That being said, 99% of learning this job is "on the job". It's not until you see the same scenario over and over that it "clicks".

Keep your chin up - you'll get there!

dog

I learned a lot by going back and re-working the cases after I didn't match the coders, to understand their logic. I have always been in a program where the CDS and the coder matching has been tracked, but I think it's irrelevant if you are working the documentation to its max. It also serves to trip up new CDSs who focus so hard on getting the same DRG as the coders that they forget they're not just reviewing charts, they're molding them.

As far as the learning curve, for me it seemed longer and harder than even when I became an ICU nurse. Because in the beginning, it feels like you're not building on anything you already know, but are just learning a whole new discipline. As you become more proficient, you will see how your background in nursing becomes critical and you will become more comfortable, and less intimidated by coding and coders, because you have something unique to offer. You will start to see beyond the DRGs and start looking for the nuance. Be patient, grasshopper.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

sbeatty

I LOVE IT! Well said.


Sandy Beatty, RN, BSN, C-CDI
Columbus Regional Hospital
2400 E. 17th Str.
Columbus, IN 47201
(O) 812-376-5652 (M) 812-552-6997


"Great leaders are almost always great simplifiers, who can cut through
argument, debate, and doubt to offer a solution everybody can
understand."

General Colin Powell

dbutler

Looking at all of the wonderful responses!!
Lots of GREAT remarks and tips.

To give you a somewhat objective perspective, I will point you to one of the ACDIS on-line polls titled "How long did it take you to get up to speed as a new CDI specialist?" and hopefully this link will work:
http://www.hcpro.com/acdis/view_readerpoll_results.cfm?quiz_id=1811

I share that with any new CDS I encounter, usually with the comment that unless the respondents who say "I hit the ground running" or "1-2 months" had strong experience doing this before, then I VERY HIGHLY doubt the veracity of those responses.
Clearly the curve doesn't peak until that 6+ month period!!

The vast majority I've talked to all agree they had moments of doubt, despair and tears during their initial several months (me included), but hang in there, most people hit that 6 month window feeling much better!!

Use the community here -- we love to help-- lean on your peers and supervisor, family and friends.
You will do just fine!

You mention that administration is anxious to see results. I am curious, what is their source for bench marking goals? If a consultant, personally I'd advise be cautious, there are some consultants that are more optimistic than others.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com


Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honor and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy
Sir Winston Churchhill