Timing of queries

sandj747@comcast.net

HELP!  I am fairly new to CDI and I have some general questions about timing of queries i.e. writing queries before the Attending has had a chance to weigh in on the documentation.  For example, if the attending has done the H/P and later that night the patient is taken to surgery and the surgeon found another issue ie  cholecystitis  when the pre op dx was appendicitis.   The attending has not seen the patient since surgery and a query is written at 6am  for the attending to document the cholecystitis (pt's surgery completed at  8 pm the night before )  this just doesn't seem correct to me... any thoughts ??

katysuegood@gmail.com

I agree with you. I would give a provider time to document the condition, especially something like that which he/she is unlikely to overlook.

sending queries preemptively will understandably frustrate providers and potentially break down the relationship between CDI and providers.

Katy

evanspx@sutterhealth.org

My preference is to allow for at 24 hours before any query..optimal is 48 hours as this provides time for analysis and comment of various studies.   We need to provide time for clinicians to study the case and provide documentation of their thought process rather than try to preempt that process.

morris-jeff@CooperHealth.edu

Agreed, That's where the autonomy of the position should come into play. They have hired you into this role for your clinical knowledge and critical thinking skills and you should also be allowed to interject some common sense. I do not know if you are under strict productivity guidelines and/or query rates, etc.. that may influence some of your decisions. I totally agree with you and Katy. The last thing you want to do is anger your Providers and make them query weary...you want them to know that when you send a query it is justified and they know it needs their attention.

Jeff

katysuegood@gmail.com

^Agree there Jeff, I tend to think that programs/CDIs who preemptively query without providing sufficient time for independent documentation are more committed to query metrics than clear, complete, and precise documentation ;-)

Katy

morris-jeff@CooperHealth.edu

paul_evans_90314 said:

My preference is to allow for at 24 hours before any query..optimal is 48 hours as this provides time for analysis and comment of various studies.   We need to provide time for clinicians to study the case and provide documentation of their thought process rather than try to preempt that process.

Agreed...I like to let the dust settle and let the Provider do some medical decision making before I start querying unless it's very obvious a query is going to be needed regardless.

Sharme.Brodie@hcpro.com

I agree with the advise that Katy has given and would add, that you need to "know" the physicians you are working with. Some physicians are okay with early placement of a query, while others are not. Some physicians do not appreciate a query being placed in a record prior to reviewing all test results and could be frustrated by the process, knowing their preferences can make your job a lot easier. an example I would give you is on the telemetry floor where patients are often discharged prior to a second review (when many queries would be placed) if the physician is okay with it, sometimes placing a query prior to all the test results being back may save the physician from being queried at a later time when the patient has been discharged. Best piece of advice I was given at the beginning of my career as a CDS was "to know your audience" and your audience includes everyone you work with including the physicians. Knowing preferences such as when it is okay to place a query or knowing how certain people preferred to be notified of something or how best they learn best, can make your life at work much better.

sandj747@comcast.net

THANKS SO MUCH !

sandj747@comcast.net

It is a very metrics driven program.

knealis

I wait until the H&P is completed and then it depends on what's happening (surgery, consult, etc.). It does help to get to know the physicians--if I have a new physician I meet with them at the start and decide what is best for them as far as how and when to communicate about documentation. It can be difficult when your metrics might go down & I think its really too bad when institutions rely so heavily on metrics without maybe fully knowing the process and the importance of CDI. Clinical validation is important too!