to specialize or not specialize
i am a CDI manager wondering what is best for my staff in view of new documentation/physician training needs to prepare for value based purchasing and ICD-10.
a - Is anyone of the school of thought that CDI's should be rotated every so often out of their unit assignments and into other units?
Advantage - CDI's with a broader knowledge base and could make more of a difference when covering.
or
b - CDI's should be unit based and if possible become specialized in those coding scenarios and service lines etc.
Advantage - would establish improved relationships with dr.'s and staff. Dr.'s more receptive to familiar face. could answer questions for other cdi's on their area. better query writing, answers, and impacts. do in-services, go to section meetings
Would I be doing them a disservice if I had scenario B - CV specialist, surgical specialist,pulm-renal spec, critical care spec, neuro-med surg spec? as ex. none have taken the cds exam.
They are doing scenario B pretty much right now. most like that because they don't like change. others would do anything. i haven't thought until now about calling them specialists. i could gather training for them targeted to their areas as well as continuing to provide general trg. etc.
what do you all think is the best for most staff and physicians? if rotating is your choice, how often?
a - Is anyone of the school of thought that CDI's should be rotated every so often out of their unit assignments and into other units?
Advantage - CDI's with a broader knowledge base and could make more of a difference when covering.
or
b - CDI's should be unit based and if possible become specialized in those coding scenarios and service lines etc.
Advantage - would establish improved relationships with dr.'s and staff. Dr.'s more receptive to familiar face. could answer questions for other cdi's on their area. better query writing, answers, and impacts. do in-services, go to section meetings
Would I be doing them a disservice if I had scenario B - CV specialist, surgical specialist,pulm-renal spec, critical care spec, neuro-med surg spec? as ex. none have taken the cds exam.
They are doing scenario B pretty much right now. most like that because they don't like change. others would do anything. i haven't thought until now about calling them specialists. i could gather training for them targeted to their areas as well as continuing to provide general trg. etc.
what do you all think is the best for most staff and physicians? if rotating is your choice, how often?
Comments
We do not rotate our staff - There are 3 of us and we have a standard assignment. We do cover for each other during vacations and call outs so we do have the opportunity to review charts on other floors.
Our physicians can be very challenging - by having a standard assignment we have been able to build relationships with our attending physicians and residents. They are comfortable approaching us - they will actually bring a chart to us and ask us if there is anything that needs to be documented.
We provide inservices as a group so the doctors will become familiar with our names/faces.
We have an excellent response rate - approx 98-99% for concurrent and post discharge queries.
In addition, when our patients are transferred we pass the worksheet to the CDS covering that area.
We each have an ICU unit, 2 CDS have M/S units. I have cardiac, CICU, CSICU, MICU, transplant and oncology. One CDS covers neuro and ortho, in addition to SICU, MICU.One CDS covers stepdown surgical and medicine.
I do think how you handle assignments can be dependent on your physicians receptiveness to CDI.
Plus, some units have "challenging" doctors. When you know you're not "stuck" somewhere forever, I think people feel that they're assignments are not something they have to put up with - they'll get their chance to move after a while.
As for people not liking change: maybe healthcare is not the place for them! Our industry is nothing but constant change!
I think specializing is good to a point: I started new CDS on a unit that they felt comfortable with so that they could focus on their CDI skills rather than trying to learn unfamiliar pathophysiology.
This system worked for us; I acknowledge that it might not work for everyone -- it depends on the personalities of the team.
Later we set our assignments. This worked nicely as well. You become more specialized in your area. You became more a part of the overall team of docs and nurses and resource management team.
Also, for set assignments, you may have an employee who has a specific background which could serve the overall team and facility such as a cardiac nurse reviewing the cardiac patients. This person may have a way of approaching those physicians to get them onboard.
Currently our CDIP has set assignments. I have enoyed investing the time and effort I have put into cultivating the relatiojships with the docs who come to my stations. They look at me as a constant resource available to them. They know who I am and what I do.
Same with the nursing staff.
There are advantages and disadvantages to both approaches. Each CDIP must decide which works best for them.
N.Brunson, RHIA, CCDS
No - I am planning on taking the exam in the fall. The 2 specialists I work with have only been doing CDI for 9 months and 18 months. I'm the veteran ( 8 yrs)- I was waiting to take the exam until I knew it would be recognized. I've been burned in the past with a certification and didn't want to repeat the experience.
on this were that we would become familiar with all different scenarios,
staff and MDs. We thought it was best if physicians saw different faces
every so often because sometimes a fresh face gets a better response to
queries.
Gina Spatafore, RN
Clinical Documentation Integrity Specialist
With the frequency of cross coverage and assistance, staff maintain reasonable competence in multiple areas along with the natural native patient variation on every unit.
We have >800 beds and 9 CDS.
Feel the relationship building is extremely important and more than offsets the drawbacks of more relative strength / weakness.
I don't feel there is a specific right or wrong -- varies with hospital and staff size, personnel issues/preference, etc. Would not allow anyone to assume they have a 'right' to stay in a given area.
Don