Verbal Queries

sbuchanan@svhs.org

I am updating our query policy and procedure and have been asked to allow verbal responses to queries to be entered either on to the query form or into the Progress Notes for the Physician to sign at a later date when he is making rounds.  This feels unethical to me with concerns for conflict of interest.  Our CDI team is a mix of coders and RNs.  Can I please have your thoughts and advice?

kbalogun

Hey Sheila, how are you? Hows St. Vincent. Just wanted to say hi.

myu1@valleyhealth.com

We have a fairly young CDI program. I was just wondering if it should be a red flag when a CDI has more than 70% of all her queries as verbal queries. Verbal queries are difficult to manage because it is hard to walk the line between asking the right question and being leading. Can somebody shed some light to this subject?

jmccorkl@stanfordhealthcare.org

Our CDI program is fully on-site with Specialists present on the Nursing units.  Even so, we infrequently use verbal queries for the above stated reason.  Also, the reality is that approaching the providers while they are rounding is disruptive to their process.  Asking about one patient while they are focused on another is apt to receive a "brush off" response.  Rather, a concise and carefully written query presented in the chart as they are reviewing and documenting for that patient is a respectful way to communicate.
Jeanne McCorkle, BSN, RN, CCDS
Stanford Healthcare - ValleyCare

jackietouch@aol.com

In our organization, written queries by the CDS are not considered a permanent part of the medical record and thus coders cannot capture any diagnoses from written queries if it is the only documentation of that diagnosis in the record. Our providers would sometimes neglect to document the diagnoses in the record or answer the query after patient discharge so we have reverted back to verbal queries. We write every query in compliant language and present to provider in the form in which it is written, giving options for unable to determine, other, etc. That written query then becomes part of the CDS worksheet. We round with our physicians, clarifying only for the case being currently presented. Since we are a teaching hospital, often queries stimulate educational discussion about indicators, risk factors, importance of documentation, CMI and a number of other topics. Our attending physicians, fellows, and residents appreciate the support of the CDSs and, for the most part, are very engaged and ask excellent questions.

Jackie Touch, MSN, RN, CCM
CHOC Children's
Orange, CA

morris-jeff@CooperHealth.edu

I feel that's a high number of verbal queries, however I do not know how your program is set up. Is she doing these queries as part of rounds or just going to Dr. Smith and saying "does the patient in ICU 2 have acute hypoxic respiratory failure since they are on HFNC"?

I am not a fan of verbal queries but realize they have their place. If you have a CDI specialist that's doing verbal queries then the verbal query must be asked just like a written one...the clinical indicators must be given and reasonable choices to the Provider must be offered. Our queries are a permanent part of the medical record so when we do one it's typed out just like one that would be posted to the chart and then the response is documented.

I would discourage that many verbal queries unless this is a very active CDI that's rounding with multiple teams and specialties on a daily basis and verbal queries are a part of that process. Make sure your policies and procedures reflect the process that's occurring or vice versa.

Interesting to hear what others do...

Jeff

hillsandovals@email.chop.edu

Hi in Phila, we round as well and do verbal queries. However the majority of our queries are written.

In the instances that we do have a verbal, they are written out in the same format as if they were emailed. Our queries are not a part of the medi record.

Steph

ssavinsk@valleyhealthlink.com

Our queries are not part of permanent medical record. What do you do when CDI enters a multiple choice query, and ( ) agree, ( ) disagree;  If the doctor responds on the query and not in medical record, how do you handle it?  I am not a fan of multiple choice if the choices do not direct the MD to enter in progress note.  Can anyone assist on their process.
sharon