Health Information Management

Strategy: Establish a daily workflow for your CDI specialists

CDI Strategies, January 24, 2008

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In order to get the most out of your clinical documentation improvement (CDI) program, seek to establish a good workflow process for your clinical documentation specialists (CDS). This will help prevent records from going unreviewed and it will also prevent CDS' from getting overwhelmed on a Monday morning after a busy weekend of admissions, for example.

Lynne Spryszak, RN, coordinator of the clinical documentation management program at Alexian Brothers Medical Center in Elk Grove Village, IL, has implemented the following seven-step process at her hospital:

  1. The first CDS to arrive in the office prints out the daily census report for each unit.
  2. The above CDS assigns new admissions to each nurse by assigned unit.
  3. Each nurse checks on a daily basis to see if any patients with outstanding queries have been discharged.
  4. Charts with outstanding queries are reviewed by the CDS who posted the query, prior to the chart being coded and usually the day immediately after discharge to assess whether the query was answered since the last review.
  5. From steps 3 and 4, each nurse maintains two files: one for answered queries waiting for patient discharge, and answered queries waiting for final coding. As these charts are coded, the final DRG assignment is entered on each query sheet as well as the initial DRG and query DRGs. Successful queries that resulted in additional revenue are then filed separately for entry into a database.
  6. Each nurse then generates his or her worklist from the hospital's computerized data system.
  7. Each CDS then performs chart reviews per his or her own schedule and is responsible for completing all charts that need review by the end of the day. In the event that one nurse has a disproportionate amount of reviews on a particular day, this is verbalized during the morning prep time and cases may be temporarily assigned to another reviewer.



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