RE: [MARKETING] [EXTERNAL] Templates
I agree with both Robert and Wendy. When I first was charged with designing our program (without a CDI background), development of query templates was a big focus of mine. It ensured that we were all querying using the same language in a compliant format. Our queries were uniform which helps the physicians and ensures they are not leading, etc. Also, they made ME as a novice feel more comfortable. They were vetted by legal and I felt more confident when using them. Also, since it was just me and one other CDI using them, it was easy to make sure we both had a good understanding of how/when they should be used. At this point though, after developing some 50 queries, I have found myself backing away from them more and more.
I find queries VERY helpful in situations where the clinical scenario is almost always the same. For example, in my opinion, every program should have a CHF query template because it is likely every hospital consistently has CHF documented but unspecified and needs to query for Acuity/type. A template will make this simpler and easier for providers. I also find them helpful in situations where a definition or diagnostic criteria is really important and may not be something providers are very familiar with. I am thinking about functional quadriplegia, for example. And it makes sense in our case (our queries are electronic with required fields) to have generic 'yes/no', 'rule in/out', 'POA', etc queries as well. There are other examples...
However, now that we have a team of 7 CDI's and I routinely audit their work, I see misuse of templates CONSTANTLY. Often questions are indirect and questions are so open ended the physician is not clear what we are asking. Our templates generally include options and these cannot be modified so the template should not be used if the options do not fit in my opinion (ex: don't include the option of functional quadriplegia when querying for critical illness myopathy if the patient does not meet criteria for FQ). Instead, we should use a generic query and provide appropriate options. Now that is my opinion but I really feel like only 'reasonable' options should be included (as the query briefs say) and the reasonable options often vary from patient to patient. I am finding that the utility of many of the queries I made early on are not very helpful (I am thinking of queries designed to determine type of shock or encephalopathy with the types listed) because the options are not valid across the board.
This has led me to actually take a step back from templating and work more intensively with the staff in developing their ability to formulate their own queries. I think there is a skill to it and it really takes practice.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
I find queries VERY helpful in situations where the clinical scenario is almost always the same. For example, in my opinion, every program should have a CHF query template because it is likely every hospital consistently has CHF documented but unspecified and needs to query for Acuity/type. A template will make this simpler and easier for providers. I also find them helpful in situations where a definition or diagnostic criteria is really important and may not be something providers are very familiar with. I am thinking about functional quadriplegia, for example. And it makes sense in our case (our queries are electronic with required fields) to have generic 'yes/no', 'rule in/out', 'POA', etc queries as well. There are other examples...
However, now that we have a team of 7 CDI's and I routinely audit their work, I see misuse of templates CONSTANTLY. Often questions are indirect and questions are so open ended the physician is not clear what we are asking. Our templates generally include options and these cannot be modified so the template should not be used if the options do not fit in my opinion (ex: don't include the option of functional quadriplegia when querying for critical illness myopathy if the patient does not meet criteria for FQ). Instead, we should use a generic query and provide appropriate options. Now that is my opinion but I really feel like only 'reasonable' options should be included (as the query briefs say) and the reasonable options often vary from patient to patient. I am finding that the utility of many of the queries I made early on are not very helpful (I am thinking of queries designed to determine type of shock or encephalopathy with the types listed) because the options are not valid across the board.
This has led me to actually take a step back from templating and work more intensively with the staff in developing their ability to formulate their own queries. I think there is a skill to it and it really takes practice.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404