CDI in ED

Our hospital is in the beginning phases of implementing CDI in our ED. Any information would be greatly appreciated...hours for CDS, workflow processes, roadblocks, etc.


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  • Hi Rebekah- I did a little work in the ED as a UR nurse and when CDI was implemented at the facility they thought the UR person would be the perfect person to do both jobs. the biggest draw back was the hours they thought this position should be more of a 11-7pm job so it was difficult to get someone who wanted the position. one of the roadblocks was wearing both hats, believe it or not when CDI was first introduced they did not believe UR nurses would make good CDI specialist because they felt providers were always trying to avoid us, not something I ever experienced myself but I can see were it may be true. there are some similarities in the workflow process, the fact that we are both reviewing the medical record and that we look at more than just the physician documentation but, we review the record for very different reasons and this would definitely require additional time. another road block that we ran into is that the ED physicians were not employees of the facility, they were contract physicians and because of this, sometimes the motivation to answer queries was not there. the person who accepts this position because of the nature of the ED must be a little aggressive (not over the top) and fast on their feet with good clinical thinking skills, interactions with the physicians would have to be quick and to the point, most queries would be verbal ones. 
  • What I've experienced for our CDI program was to somehow get our foot in the door.  While we're not doing outpt CDI yet, being invited to departmental meetings (not only ED) or case rounds or other staff meetings was a big step for us.  It allowed us to put education topics on the table and became a short discussion.  The biggest obstacle was coming up with material that we could compress into a 5-minute presentation - kind of like the theme for the ACDIS conference this year... what's the one thing we wanted the physicians to take away.

  • I think it is important when you enter the ED to clearly define why you are there? Are you reviewing likely admissions to assure capture of all appropriate diagnoses? Are you reviewing to assist providers with E&M? Is your focus charge capture for treatments? It is important to understand the expectations of why you were asked to go to the ED to assure you are communicating that effectively to the providers. In my personal experience most ED providers assumed my interventions were to assist with E&M, although that was not really my focus- a knowledge of the requirements and process of E&M did assist me in getting my foot in door- even if that was not my primary focus. 
  • Thank you all for your responses. Our providers in ED are eager to start CDI in ED, since we recently found out it was added to their contracts. So they are willing to work with us, which is a great first step. The world of professional billing is very new to me and I am still trying to fully understand that portion. This is an exciting project and I look forward to jumping in. Any more tips and tricks would be great, I also appreciate feedback!

  • Hi Rebekah,

    I'm not in CDI personally (I'm the ACDIS editor), but I did want to pass along a few resources from around the website that might be helpful for you:
    Feel free to reach out if you're looking for a particular resource too! The ACDIS family is always willing to help :)
    Best of luck!

  • Thank you so much for this information!!
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