Resp Failure
Looking for some help...
Would anyone be interested in sharing what criteria you use when reviewing a chart to help capture Acute resp. failure.
Currently we use the criteria noted from the CDI pocket guide.
I had a MD tell me today, from a review company we are using , I could query for acute respiratory failure, it concerns me , pt. was on NC 2 l, not known O2 dependence , had initial O2 sat of 88% on admission, lungs with wheezing, no retractions. resp. rate ranging the highest was 24.
Opinions, should and could this qualify as acute resp. failure.
Tiffany Andras LPN CCS CCDS
Clinical Documentation Improvement
Thibodaux Regional Medical Center
602 North Acadia Road
Thibodaux, La. 70301
985-493-4593
Would anyone be interested in sharing what criteria you use when reviewing a chart to help capture Acute resp. failure.
Currently we use the criteria noted from the CDI pocket guide.
I had a MD tell me today, from a review company we are using , I could query for acute respiratory failure, it concerns me , pt. was on NC 2 l, not known O2 dependence , had initial O2 sat of 88% on admission, lungs with wheezing, no retractions. resp. rate ranging the highest was 24.
Opinions, should and could this qualify as acute resp. failure.
Tiffany Andras LPN CCS CCDS
Clinical Documentation Improvement
Thibodaux Regional Medical Center
602 North Acadia Road
Thibodaux, La. 70301
985-493-4593
Comments
We use the CDI Pocket Guide, the resources on cdimd.com, and SF ratio (as appropriate). In the example you have given, I would not clarify for acute respiratory failure. I would probably ask for clinical validation from the MD if I saw it documented on the record of a patient with the clinical indicators and treatment that are in your example.
Yes, qualifies as acute respiratory failure.
Criteria used by CDI team:
Treatment: Oxygen >40%, via facemask
Query the Physician
The original citation states 2L NC - recognizing the variations in clinical definition, in my view, only 2L negates ARF...this equates to 28% FI02
Suggest you search for this topic using the 'search' option and you will find several presentations on this topic. Personally, I compute the P/F ratio and you can find that formula within such articles.
There is no consensus but check out the ACDIS White Paper on Pediatric Respiratory Failure. Are you looking at NICU charts?
jwmorris1,
Thanks! I'll check that out. We don't have a NICU, so I doubt we see any pediatric respiratory failure--at least, not without quickly transferring them out.
Hannah,
What type of infants are you looking at?
You can query based on what is in your question. The risk is the MD will say yes to a diagnosis that is not supported throughout the record. You can get the diagnosis on the front side and end up appealing, or accepting a denial on the back side.
Looking at this from a denials perspective, I would be very careful about querying for respiratory failure based on a single low sat and wheezing.
Was there increased work of breathing? Did the wheezing resolve with a single nebulizer treatment?
Does additional documentation bring in any history of chronic respiratory failure/home O2 use?
Approximately 40% of the denials that my facilities receive are for respiratory failure and I cannot support 60% of those based on documentation in the chart.
Ideally, I want to see documentation of repeated low sats on room air, increased work of breathing, SOB, inability to speak in complete sentences etc. that is consistently documented. Yes, patients, especially pediatric patients can have a fast turnaround in symptoms with appropriate treatment but that should be clear based on documentation of response to treatment.
I agree with asking your advisor what criteria they are using and asking how confident are they that the diagnoses using that criteria would be upheld by an auditor.
Cynthia Mead RN CCDS
Denials Management
Flagstaff Medical Center, Northern Arizona Health
Flagstaff AZ