CDI Reviews for Observation Patients

JMontg01

We are exploring the opportunities for CDI reviews in  Observation environment.  Our facility has a high OBS admission rate thus reviewing OBS patients may prove beneficial in decreasing the OBS admission rate.  We are an Epic and 3M system, but 3M does not support APC finder for the CDI module.

Is anyone reviewing OBS admissions?  What is your process? What are the greatest opportunities?  If you are using 3M, how are you managing concurrent reviews for this environment?

Any information would be beneficial.

bmurphy@hcpro.com

Hello, great question. I would recommend starting by reviewing this slide presentation delivered at the 2017 ACDIS conference: https://acdis.org/resources/2017-conference-day-3-track-5-new-documentation-frontier-expanding-cdi-outpatient. The speakers' contact names and email addresses are at the back.

I also had this session on ACDIS Radio, which you can listen to here: https://acdis.org/acdis-radio/acdis-conference-preview-expanding-cdi-outpatient-observation-setting

lprescott1

i find in my travels that most people who are reviewing OBS records are reviewing them with the goal of  assessing if a switch to inpatient admission might be beneficial. Or are you reviewing for charge capture?

gth8088501@aol.com

I reviewed OBS patients for several months with the goal of capturing opportunities for admission. This was eventually discontinued. I did not find any significant opportunities as there was a case manager in the ED who tracked these cases. Also, it was challenging to determine who was the attending physician assigned to the case as this changed often. If there were queries, one had to determine to whom to send them. I used the same process for regular admissions that our organization used for the observation cases.

cynthia.mead@nahealth.com

Our team used to review all obs status patients for query opportunities and stopped doing the reviews due to CDI's finding few opportunities to impact the record. Our UR nurses are reviewing concurrently to determine inpt vs obs and really didn't need our input.

Cynthia

cherylstonge

cynthia.mead@nahealth.com said:

Our team used to review all obs status patients for query opportunities and stopped doing the reviews due to CDI's finding few opportunities to impact the record. Our UR nurses are reviewing concurrently to determine inpt vs obs and really didn't need our input.

Cynthia

I agree with this, I let the UR director know that if her UR nurses review a chart and feel that there may be more going on to refer the chart to the CDI team for a quick review. UR nurses are trained to use what is documented, CDI nurses are trained to read between the lines.

Sharme.Brodie@hcpro.com

This is a great position to have a CDI specialist who also has experience in UR so they can work the ED and OBS not only looking documentation issues that may require a query for clarification but also helps with the documentation needed for medical necessity.