Post-Discharge Query Answers

arsusott@msn.com

We recently had an auditor at our facility who suggested the CDI "own" the queries for 3 days post d/c to try to get the query answered before the coders get the chart. I have read the message posted 4/11 "Answering Queries: What's Your Method". Just looking for any additional comments. I believe we have a response rate of about 85% and are looking to try to get that to 100%. Our physicians have pretty much told us they don't want to be interrupted by verbal queries during the day. So almost all of our queries are written. Our hospitalist are not employed by the hospital we contract them in. We run into problems in the hospitalists schedule, like I am sure other hospitals do, that they work maybe 7 on 7 off so then how do you get that doctor back in when he is off. To date if the query isn't answered the coders will put it in the doctor's box but we are looking to get the query answered before that. We don't feel our doctors are the type that would go for treats such as coffee, donuts, etc. to get them to answer. Is paging the best way? E-mails? Other? Thanks for any other ideas.

murpca2

I have had similar problems here as well. I also have the problem of posting a query and then the hospitalist coverage changes mid way through the stay and the new attending doesn't want to answer the query (for various reasons.)

Our hospitalist are also not employed by the hospital and typically work 7 on 7 off so I started printing a copy of the call schedule and when I see that it is the hospitalists last day on and a query left for him has yet to be answered, I page him and remind him it needs to be taken care of before he leaves that day. Also, when making my daily rounds, if I see discharge orders on one of my queried patients that still is unanswered, I page the physician for this as well and ask that if he has not addressed the issue in the discharge summary, he either dictate and addendum or sign the query.

This seems to be working here, at least for the time being.

catladyrn

In my previous job, I owned the queries until they were answered; if the patient was discharged prior to me getting a response, I notified coding to hold the chart until I could get it answered. Needless to say, my boss pushed very hard for me to get it answered before the record hit the DNFB list, and she didn't care what I had to do to get that answer. In my current job, the queries are supposed to roll over to coding after discharge, but the reality is that the coders almost never follow up on my queries and the charts get coded without an answer. So I have a high no-response rate (also high blame on the flaws of our EMR). It is the bane of my existence.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

Unknown

I own my queries for 48 hours post discharge.

The first thing I do every morning is check previous queries for answers so I know which physicians to hunt down. I probably get 95% answered predischarge.

If I am unable to get answers in 48 hours, the coders takes over and assigns a deficiency. I think, in the 3 1/2 years I've been doing this, after discussion with the coder (usually due to other documentation) we have decided to not pursue a query post discharge.

I have about a 99% query answer rate.

Charlene Thiry, RN, BSN, CPC, CCDS
Menorah Medical Center

dallend@einstein.edu

We deal with residents for the most part. Our final answer rate is 100%. CDI owns all queries at our faciity - concurrent and post discharge. We page our residents post discharge. If we do not receive a response we contact the department administrators who assist us in dealing with the more difficult residents. Occasionally we will assign a post discharge query to an attending - we will either email or page the MD - based on MD preference.

dvitalone1

Paging them here makes them angry.
We are located in HIM so we catch majority of them in HIM.
We also fax to offices with a great response or send a message to all case mgrs to call us if they see the specific doctor we are looking for
Dawn