Additional "help" for CDI

Recently we have asked our organization to add additional staff to our department. We currently have 4 CDI specialists reviewing 78% of our Medicare population. We were approved for 1 additional CDS, and also told that we should explore whether we have non-bedside RNs who could potentially cross train with CDI and "help out". In an effort to take advantage of this offer, does anyone know how we could make this work? We essentially have a workflow like most all of you, we are 100% EHR, we reconcile with the coders, etc. My first thoughts are "there is no way someone can just come in and review charts 2 days a week and then leave the department; not able to follow up on queries, or reviews." However, I would like to know if there is any other ways that we could take advantage of additional help. Any additional comments, thoughts, questions would be appreciated. Thank you!


  • First, let me acknowledge I am NOT an RN.  But, I feel the CDI profession is advanced and complicated and I generally do not feel anyone, regardless of background, can be expected to perform successfully in this endeavor on a part-time basis.  Perhaps they could scan the issued queries for responses and alert the CDI staff of responses?   Perhaps they could scan labs and notes and then funnel them to trained CDI professionals?  But, my general opinion is that CDI reviews have never been suitable as an additional duty.

    Paul Evans, RHIA

  • Thank you, Paul. I appreciate your comments and I agree....completely. We are struggling with trying to figure out how this will work, as we don't think it will, but we have to "try". I appreciate your suggestions more than you know! :)
  • The problem with double duty is competing interests. 

    I agree with Paul in that I have never really seen this done with success (when interests compete)-- however, I think that if you are offered to cross train a non-bedside Nurse to become a CDS, you should definitely take the offer. 

    I would implement a full training program and I would invest in that person learning all the fundamentals of CDI through formal training.  It is possible to be part time, but full day-- is a must.  If they are making Discharge plans or doing UR, it will definitely not work because the first priority will be the safe discharge plan for the patient.  If you are able to work out a 'regular' Part-time position, that would be ideal. 

    As nurses, we are trained to 'give report'.  If done correctly and the cases are 'reported off' to an assigned CDS for follow up, this can work very well.  In fact, I have seen this work so well that additional FTE's were given because of the potential benefit to the Department, Facility etc.    Go for it !

  • Thank you, Kelly!!! I really appreciate your comment! I hadn't thought of the "give report" idea. Great thought! :)
  • I agree with the idea that it needs to be part time and not just a random help.  My hospital is smaller than alot of others on this forum, I am full time but the only CDI here.  My "helper" was a UR/casemanager and she came to help me 4 hours every other week and then cover my vacations.  In my opinion, it did not work well.  In some ways it was starting all over again each time she came and then when she did sign off to me, I frequently had to re-review her charts so it was less productive than helpful.  
  • Agree with Kelly above, and others in regards to intermittant assistance.

    I would however encourage you to give some consideration to all of the aspects of your CDI program (some ideas in addition to Paul). 
    Is there data collection or follow up than can be done?
    Do you currently have a way to categorize the topics of queries asked?
    Do you need to manually collect data and manually input into a data base?
    Are there reports that need to be prepared?
    Would there be clinical topics that could be researched, summarized, and then preseneted to your CDS's?
    If you have some, or even many, automated reports, is there additional detail that you would find valuable but could only be added manually?

    Any component of the CDI process that is manual, and does not require in depth CDI skills/knowledge ...

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