CDI flow process

In an effort to increase the amount of Medicare charts reviewed and decrease retrospective queries, our department has been brainstorming some ideas on how to restructure our daily process. One model suggested was having 1 work que for all the CDIs. It would be categorized by chart priority, and not assigned to any one CDS. 

Has anyone ever designed a process where no one "owns" the chart and the charts circulate between CDIs until Discharge?


Keri Miller RN BSN CCDS


  • I somewhat like that idea- because it can reinforce learning among  the CDI staff- they see each other's work. If this process is in place it is important that the CDI staff clearly document their review notes so if picked up by another the process does not slow due to lack of info.
  • edited September 2018
    In a large system where not all encounters get reviewed due to sheer volume, I can see the merits of not having a CDI assigned but from a lean perspective I would likely be reviewing documentation already reviewed which is essentially doubling or tripling the time spent reviewing an encounter.  I could start where someone left off based their notes but I couldn’t be assured that the documentation was consistent between providers or that the working principal diagnosis is correct without going back to the ED report H & P and checking the timeline for rule outs etc and the discharge summary for confirmation of the final discharge diagnosis without reviewing again something already reviewed.  This would be duplication of work. Then again if the goal is MCC and CC capture only in the correct DRG then it may be efficient enough on a large scale.  Retrospective queries are a given if CDI do a final review of the discharge summary.  This data shows up in reports but need to be taken into consideration.   I agree that it would be a positive if it led to greater learning for CDI’s.
  • Currently our work flow is all CDS's  work in one department.  I am interested in finding out if there are programs that have CDS's on each floor and do not have one location they all work in together every day. 
  • We are currently looking at our workflow.  We have been unit-based and are now reviewing by Alpha.  We found that if we are unit-based, we become a expert on that floor and could provide education in that particular area. When someone was out sick or on extended leave, it was an issue with coverage. With the Alpha model, we were challenged to become well-rounded and self educate with new areas that were unfamiliar to us.  We have a dedicated office space off the floors.  We go out to the floors to provide one on one education as needed. Anyone have any thoughts pro or con for either model?  

    Cheryl Catlett
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