Hospitalist Programs

terrierprideterrierpride
in CDI Talk Archive
Hello all! I was just wondering if there are any CDI Professionals out there who are troubleshooting the query process when dealing with a Hospitalist program. For instance, if our Nocturnist accepts a patient then they write the H&P, then when the next Hospitalist comes on they would do a progress note when they round. Then for fun let's say it's their last day of their week and the next day a new Hospitalist takes over the management of this patient. So that's 3 different attendings in 2 days! Or even better let's then on Day 3 the patient's PCP assumes care of the patient having been signed out to the Hospitalists over the weekend. I know any and all practitioners could answer a query but I am often hesitant to query if I know a new Provider is going to do their "1st" assessment of the patient the following day. Am I crazy or are their others out there dealing with this as well? I'd love any constructive criticism!

Kevin O'Neil, RHIT
Herrin Hospital

Comments

  • ddouthitddouthit
    edited May 2016
    Kevin,

    Our hospitalist work 7 days on and usually see the same patient's during that time, but if for example on Day 5 patient has a query and it is not answered when hospitalist gets off on Day 7 the query carries over to the next hospitalist for completion. By the same token, if patient is discharged on new hospitalist first day seeing patient, it is the new hospitalist responsibility to complete query. We do track if Hospitalist A didn't complete query and it was moved to Hospitalist B.

    Dorie Douthit, RHIT,CCS
    ddouthit@stmarysathens.org

  • sharon.colesharon.cole
    edited May 2016
    We are still using a hybrid record so still type up paper queries. Our hospitalist's do the same thing as do several other specialty groups. I begin the query:
    Dr Brown, and/or associate,

    Sharon Cole, RN, CCDS
    CDI Specialist
    Providence Health Center
    254.751.4256
    Sharon.cole@phn-waco.org

  • cstukenbergcstukenberg
    edited May 2016
    Our hospitalists are 7 on 7 off but there are times when they switch more frequently or they are changing from one group to the next and can have multiple on the case. I do not wait because we are trying to keep our documentation concurrent. If I have to wait, then I may miss an opportunity to keep the documentation concurrent. Retro queries for hospitalists are really a challenge when they only saw the patient once.
    Colleen

  • angelisa.romanelloangelisa.romanello
    edited May 2016
    We have an unspoken policy here. We query when the need arises regardless of the hospitalist schedule. Our patient's are often times seen by specialists in addition to the hospitalist so the sooner the query is placed on the medical record; the more providers will have an opportunity to answer.

    Kevin, you are not crazy....we struggle with this especially when it comes to POA queries.

    Another positive aspect of leaving the query is that the new provider or the hospitalist who will assume care of this patient, has fresh eyes or possibly the query may prompt them to dig deeper into the chart.

    I believe we all struggle with this changing of the guard but it is doable.

    Good Luck.

    Lisa Romanello, RN,BSN,FNS,CCDS
    CDI Specialist
    CJW Medical Center
    Chippenham Campus
    804-228-6527


  • Unknown
    edited May 2016
    We send it to the MD who is caring for the pt when the need arises to
    send it! Thanks J

    Jamie Dugan RN
    Clinical Documentation Improvement Specialist
    Baptist Health System
    office:904-202-4345
    cellular: 904-237-7253
    Business Email-jamie.dugan@bmcjax.com
    cdis.icd10@bmcjax.com

  • paxnerospaxneros
    edited May 2016
    We address our Hospitalist queries, "Dr. HOSPITALIST"

    That way it doesnt matter who comes in to view the record- we expect them all to answer. Our PA's and ARNPs who work w/ the Hospitalists refer to themselves as "hospitalists".

    Occasionally I will address the query "Dr. Hospitalist/Neurology" (or any other specialty which may be consulting) if I wish to get a specific answer to my question.

    NBrunson, RHIA,CDIP,CCDS

    CDI Talk wrote:

    >We are still using a hybrid record so still type up paper queries. Our hospitalist's do the same thing as do several other specialty groups. I begin the query:
    >Dr Brown, and/or associate,
    >
    >Sharon Cole, RN, CCDS
    >CDI Specialist
    >Providence Health Center
    >254.751.4256
    >Sharon.cole@phn-waco.org
    >
  • terrierprideterrierpride
    edited May 2016
    Thanks everyone for the feedback and support! Glad to know I'm not alone. : )
    We are trying to work through leaving concurrent paper queries for our 95% electronic Hospitalists. Needless to say we end up with some queries that don't get answered. Then we have to import the query into the EHR and assign a deficiency to 1 specific provider like coding. This is where I get hung up because we don't have a clear policy on who the attending should be other than to say, "there should be clear documentation of the attending physician in the record". Unfortunately that seems to be lacking many times.
  • lprescottlprescott
    edited May 2016
    kevin, we feel your pain. I have done some education with the hospitalist physicians to explain the importance of consistency and the need to review what is written in record by previous physician. The queries go to the physician active on the case at the time and any retro queries go to the discharge physician. But i remind them query rate would be lower if they assurred consistency in documentation and when they disagree clearly document what has been ruled out/in/remains possible upon their consideration.

    We do find it is difficult to maintain a clear query rate on individual hospitalists as they all overlap even with a 7 on 7 off schedule.
    Laurie L. prescott RN, MSN, CCDS
    lprescott@morehead.org
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