Staffing

vleadbetter@cmcvtx.orgvleadbetter@cmcvtx.org
in CDI Management
Good Afternoon,
I was wondering if anyone adjusts their staffing to the census? We are looking at flexing our CDI staff to take off if our census drops.  I am looking for a formula or some guidance on how to staff the CDI department based on the daily census. 
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Comments

  • lprescott1lprescott1
    I do suggest you work in activities that can occur when census is low- for example a great time to do develop and deliver provider education opportunities, and of course staff development. I maintained a list of activities that we wished to complete but did not have time and when the census dropped we had a go to list of priorities that had been put off due to no time available. There is more to the CDI job than record review.  I do agree though that with census drops there might be time off as well.
  • morris-jeff@CooperHealth.edumorris-jeff@CooperHealth.edu

    Agree with Laurie. When our census drops the staff are working ahead preparing the next round of provider education, tip cards, posters, showing more visibility on the units to answer MD questions, etc.. Do you also review HAC, PSI, mortalities? I have been the sole person doing mortality reviews so I am about to teach several staff how to assist me with that. We are a two hospital system, also working on cross coverage between the facilities. We also take this opportunity to do self education and have educational meetings with coding, We are salaried so there's really not an option to send people home based on census.


  • aliciasmail@twc.comaliciasmail@twc.com

    is there a standard or benchmark for the percentage of CDI staff allowed off per day or per week?

    thank you!

  • lprescott1lprescott1
    Alicia, I know of no benchmark as the staffing model and mission of CDI departments can vary greatly. for example if you only staff 2 CDI- both being off the same week is not a good plan.  I would suggest if you are trying to scale your staff by census you work to quantify how many records can be reviewed in a day and somehow attach that to the number of patients. For example, staff to maintain the ability to work 75% of full capacity based on census- not sure if this makes any sense?


  • tracyaboldt@gmail.comtracyaboldt@gmail.com
    edited October 2018

    Alicia, one recommendation you may consider is to review accounts retrospectively if there was not an initial review by CDI.  Our team also performs second level reviews for the following:

    1. DRGs without cc/ mcc and DRGs with cc looking for a mcc

    • Do not send accounts already reviewed by CDI on day of discharge or day prior to discharge.

    1. Only cc or Only mcc that impacts the DRG

    • All accounts where the clinical criteria for the only cc or only mcc diagnosis that impacts the DRG if the supporting clinical criteria is not documented in an CAC tool comment and/or CDI query should be sent for second level review. The inpatient coder should add “Only CC” or “Only MCC” in the comment field.
    • The CDI Specialist will only review the cc/mcc diagnosis to determine if the clinical criteria have been met.

    1. DRG mismatch

    • Do not send accounts to CDI to review if subsequent documentation was added after the last CDI review that resulted in a DRG mismatch.

    1. Mortality accounts less than 4/4 (excludes CAH’s)
    2. Additional query opportunity based on coding's review and partner with CDI
    3. Accounts excluded from second level reviews:

    • Moms/babies
    • Healthy elective (scheduled) joint replacements without mcc regardless of LOS
    • Behavioral health
    • Critical Access Hospitals
       

    The above recommendations would enable you to staff consistently through the week and avoid weekends. We have tried staffing on weekends only to find it to be a job dissatisfier. Our staff is salary which allows for the team to flex hours to ensure work life balance is satisfied.  I do not recommend staffing based on census as consistency is the key to relationship building with providers. 

    Are you offering educational sessions over breakfast/ lunch for providers, Rounding with providers and ancillary support teams, meet and greet sessions, CDI orientations for new practitioners? We require our team to obtain a specified amount of CDI education each month which can be completed when there is down time. 

    The hours spent away from traditional review are captured for various reasons such as: compliance, hours of CDI education, hours of practitioner education on a monthly basis .  It is important to educate up front vs catch it during a review or on the back end. The fruits of your labor will encourage providers to document appropriately and reduce queries. We strive to reduce queries as it is time consuming to craft queries and providers would rather not receive queries.  Education and relationship building is the key to a successful CDI program.

    I am happy to share any resources you may need to show educational growth. 

    Regards,

    Tracy Boldt

    Essentia Health System

  • martha.khayyat@providence.orgmartha.khayyat@providence.org

    Does anyone have experince with a CDI float pool across an organization with multiple hospitals? If so would you be willing to share policy related to the CDI float pool and experinces you encountered- positive and negative?

    Thank you in advance

    Beth Khayyat

    Providence Health

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