Definition of Catheter Associated UTI for CDI queries

A question has come up about querying for catheter associated UTI.
We are interested in hearing whether you all use the CAUTI definition as criteria for querying or if you are querying even if the definition is not met and it is possible that the UTI is related to a foley catheter.

Example: Initial UA in ED was negative. No culture done. Foley placed in ED and removed approximately 4 hours later on the Med Surg floor. 3 days after the foley was removed a UA was repeated and culture done revealing E. Coli UTI.

Would you query? Not query as it doesn't meet the CAUTI criteria?

Thanks for your help,
Jan

Janice Potter, RN, CCDS
Clinical Documentation Specialist
Care Management Department
(406) 327-4298
jpotter@communitymed.org

Comments

  • Great question. I am very curious what everyone has to say. We are having the same question here as there is dissonance between what our Infection Prevention team determines as a CAUTI versus general medical opinions of the providers.

    Thanks!

    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


  • Given you are describing a scenario whereby the foley was only in place for 4 hours, I would not query for CAUTI. Does not seem consistent with clinical practice.

    Thanks, PE

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

    evanspx@sutterhealth.org



    -----Original Message-----
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, December 02, 2014 9:53 AM
    To: Evans, Paul
    Subject: RE: [cdi_talk] Definition of Catheter Associated UTI for CDI queries

    Great question. I am very curious what everyone has to say. We are having the same question here as there is dissonance between what our Infection Prevention team determines as a CAUTI versus general medical opinions of the providers.

    Thanks!

    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


    -----Original Message-----
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, December 02, 2014 8:37 AM
    To: Kathryn Good
    Subject: [cdi_talk] Definition of Catheter Associated UTI for CDI queries

    A question has come up about querying for catheter associated UTI.
    We are interested in hearing whether you all use the CAUTI definition as criteria for querying or if you are querying even if the definition is not met and it is possible that the UTI is related to a foley catheter.

    Example: Initial UA in ED was negative. No culture done. Foley placed in ED and removed approximately 4 hours later on the Med Surg floor. 3 days after the foley was removed a UA was repeated and culture done revealing E. Coli UTI.

    Would you query? Not query as it doesn't meet the CAUTI criteria?

    Thanks for your help,
    Jan

    Janice Potter, RN, CCDS
    Clinical Documentation Specialist
    Care Management Department
    (406) 327-4298
    jpotter@communitymed.org

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  • edited April 2016
    Jeff,
    It is interesting you should ask this question today. I have just participated in a meeting here ( our CDI department is part of quality) to attempt to determine the correct way to handle CAUTIs and NHSN criteria.

    We came to the conclusion they may not always agree. The criteria for NHSN is different in relationship to POA of the UTI.
    We have decided to proceed as follows:
    CDI will work on determining if the documentation can show whether the UTI was POA or not.
    ICP will work on the NHSN criteria and we will keep a spreadsheet to be sent out once a week to review these cases.
    The rationale for this is that our hospital requires a root cause analysis for every CAUTI.
    I am also trying to collect enough data to convince our doctors that the orders need to be written to collect the UA prior to placing the foley. It seems our ED staff will place a foley and then the UA is not collected for several days.

    I hope this makes sense and helps a little.
    Lisa


    Lisa Romanello, RN,BSN,FNS,CCDS
    Manager, Clinical Documentation Improvement
    Quality and Compliance
    CJW Medical Center
    Office phone: 804-228-6527
    Cell phone: 804-629-0396
    AHIMA Approved ICD-10 CM/PCS Trainer
    Angelisa.Romanello@HCAHealthcare.com





  • We do not agree either. The criteria NHSN uses is different than Coding. They have some on their list that we don't have and vice versa; two different reporting structures.

    Sharon

    Sharon Cooper, RN-BC, CCS, CCDS, CDIP, CHTS-CP
    AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
    Manager Clinical Documentation/Appeals

    sharon.cooper@owensborohealth.org
    (270) 417-4612 Office
    (270) 316-9088 Cell
    (270) 417-4609 Fax

    Owensboro Health Regional Hospital
    P.O. Box 20007
    Owensboro, KY 42304-0007

  • My 2 cents on querying if it doesn’t meet NHSN...
    I don’t think this is a place for CDI. I know we are able to query for diagnoses without clinical indicators but this is not generally the case in these instances. For example, a patient may develop a UTI 3 days after foley insertion and document a CAUTI but our IP team may not consider this a CAUTI because the patient was afebrile and they were sedated and therefore unable to communicate any pain. However, the providers independent opinion is that this patient has a CAUTI and I think that’s a reasonable diagnosis even if it doesn’t meet NHSN criteria. I think a query would only be indicated in a circumstance where (for example) a CAUTI was documented on a patient that did not have a foley or something overt like that.
    I think about this as similar in ways to malnutrition. If a provider assesses a patient with cancer and determines weight loss, low albumin, and decreased intake indicate malnutrition, I would not query simply because the patient does not meet ASPEN criteria even though that may be my preferred criteria. Cheryl Ericson wrote a blog about this last year. I think we should trust physician judgment in most cases.

    On another note, at a presentation at the ACDIS conference (I think in 2013??) someone suggested that the terminology of 'CAUTI' does not indicate causation. Their feeling was 'associated' does not mean 'due to'. They suggested that we should not be coding based on documentation of 'CAUTI'. I have never seen this anywhere else????

    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


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