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?



  • Lately I feel like I need to bring my popcorn to these discussion.


  • kolotoure,

    You had some interesting points but it was all lost in the personal attacks...I appreciate your passionate response deem has been "blunt". 

    Tales of clinical documentation improvement are stories from real CDS encounters that I have decided to publicize to other professionals in the field. I think nothing is lost, we can all learn from other's experiences.  

    I disagree that CDS are only good for hunting CC's and MCC's to paraphrase you. We contribute in a lot of ways and financials are just a by-product. To your point in my opinion the greatest CDS that ever Liveth is late Dr. Gold (RIP). 

  • Lately I feel like I need to bring my popcorn to these discussion.


         I never knew so many have such a disdain for our profession. Interesting...
  • I agree and I find the comments made by kolotoure inappropriate and divisive.  This forum is intended to be a place in which we can share ideas and thoughts in a respectful manner.  For the past few weeks, this has not always been the case.  Frankly, I think this is all the same person simply changing his e-mail address so that he can continue to speak so inappropriately and anonymously.


  • Thanks for your patience everyone as we work to remove these posts. There is no place for personal attacks on the ACDIS Forum, kolotoure. We will be removing these posts, and posting rules for proper forum etiquette for everyone to follow. 

    Brian Murphy
    Director, ACDIS
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