PEA, bradycardia, apnea

cmclose@saintfrancis.comcmclose@saintfrancis.com
edited May 2016 in Pediatrics
Any suggestions for PEDIATRIC pt that has extensive LOS, came in resp
failure, hx heart disease (she had surgery later on while she has been
here for VSD repair and then GT and fundo), had pneumonia, sepsis, ac on
chronic combined CHF that had CPR documented x2 (no meds; compressions,
bagging) once for PEA after hypoxic with crying episode and "stopped
breathing" and the other for "episode of bradycardia and apnea"? Query
for resp arrest/clarify apnea??? Management wanting justification for
pt's extended LOS (65days). CDI is relatively new for peds here so
having tough time with getting docs to answer the queries (no physician
advisor). I already have MCC's and CC's on the chart. Anyone else having
to deal with justifying extended LOS's? Any advice is appreciated!

Claudine Hutchinson RN
Clinical Documentation Improvement Specialist
Children's Hospital at Saint Francis
Email: chutchinson@saintfrancis.com
Office: (918) 502-6603
Pager: 98-1001

Comments

  • robert.hodges2robert.hodges2
    edited May 2016
    Sounds like a Utilization Review/Case Management issue. Based on what I
    see here it sounds like the child is lucky to be alive.



    Robert


    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
    P: 989-497-2500 x13101
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    E: Robert.Hodges2@va.gov

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  • cmclose@saintfrancis.comcmclose@saintfrancis.com
    edited May 2016
    Adult CDI is part of Case Management here and they have UR committee.
    Yes Robert~ I think so!

    Claudine Hutchinson RN
    Clinical Documentation Improvement Specialist
    Children's Hospital at Saint Francis
    Email: chutchinson@saintfrancis.com
    Office: (918) 502-6603
    Pager: 98-1001
  • kshumpertkshumpert
    edited May 2016
    I agree with the UR/case management approach. I don't justify the length of stay here. MCCs and CCs help to support the severity of illness and risk of mortality for the stay. If you already have the documentation to support them, what else can you do? There are far too many factors that play into length of stay such as an appropriate discharge disposition.


    Kathy
    Kathy Shumpert, RN, CCDS

    Clinical Documentation Improvement Specialist
    Howard Regional Health System
    Office 765-864-8754
    Pager 765-454-3465
    Fax 765-453-8152

    When something can be read without effort, great effort has gone into its writing. ~Enrique Jardiel Poncela
  • digardskdigardsk
    edited May 2016
    Sounds like you have a surgery with a lot of severity - which is about as good as you can do without a trach. I agree with others that LOS belongs in another ballpark than CDI.
  • michelleclynemichelleclyne
    edited May 2016
    We do not have to justify LOS here, that is the Care Management
    department. I would think that if Administration was given a brief
    synopsis (such as you described here), they would understand the need
    for the LOS. It appears that you are a specialty hospital, where else
    do they think the patient can go...
  • cmclose@saintfrancis.comcmclose@saintfrancis.com
    edited May 2016
    I think they want to make sure it gets assigned to the right (highest)
    DRG, which being she's had 2 surgeries I would think that would control
    that (DRG assignment) BUT I am new at this and learning. Adult CDI is
    under Case Management here, which 1 of my bosses is the director of. My
    other boss is the exec director of children's hosp. (Yes, I have 2
    bosses). I appreciate all the responses!!! This site has been a real
    asset!
    Claudine Hutchinson RN
    Clinical Documentation Improvement Specialist
    Children's Hospital at Saint Francis
    Email: chutchinson@saintfrancis.com
    Office: (918) 502-6603
    Pager: 98-1001
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