Rainy Thursday Morning
On this rainy Thursday morning, the CDS on the 5th floor observed the following dialogue between an attending and consulting urologist:
Urologist – Dr. X I have not so great news for you… this patient was originally scheduled for outpatient removal of stone but the patient rescheduled due to weather. Unfortunately, I can’t operate on this patient because another provider documented patient has UTI but I don’t think its UTI the pyuria is as a result of recent stenting of the left renal artery.
Attending – Really? Dr. Y was following the patient in my absence so I am unaware of the diagnosis. Was urine culture obtained?
Urologist – No but I ordered one yesterday to confirm or rule out the diagnosis. Unfortunately, this patient will have to be optimized and diagnosis of UTI definitively confirmed and addressed before surgery will take place. Also, I am going on vacation tomorrow so I will not be back for a week.
Attending – Can one of your on-call doctors perform the surgery?
Urologist – I doubt it because of the UTI on the patient’s chart that will need to be confirmed or ruled out before surgery will take place.
Attending - This patient is now day 2 of admission, this will mean at least 3 more days to get the patient out after surgery. I am frustrated! Thank you for your help and enjoy time off
Urologist – You bet!
• Current PDx: Renal calculus obstruction with hydronephrosis
• Working DRG: 694 GMLOS 2.1
• Potential Surgical DRG: 660 GMLOS 3.4
• Expected GMLOS – 5
The CDS was concerned about the possibility of the patient decompensating with prolonged LOS, so called Dr. Y to clarify the diagnosis of UTI.
The result of clarification: UTI ruled out no growth and abx will be D/C.
At around 3 pm, the CDS was looking for the patient’s chart (paper charting system) to add DRG severity sheet and the nurse informed the CDS chart is not on the floor because the patient was taken to OR for surgery.
As the CDI manager, how would you capture this CDS impact?
a. Validation of a diagnosis
b. Avoiding a potential medical necessity denial
c. Improved patient satisfaction
d. All of the above
How can we better demonstrate to the C suite our impact is just more than capturing CC's and MCC's ? Any suggestions?