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Shake up the routine in your CDI efforts

CDI Strategies, March 20, 2008

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Tips to improve the efficiency and effectiveness of chart review

CDI specialists need to shake up their routine once in a while if they are to maximize their effectiveness, says Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS, an independent consultant located in Maryville, TN. If a CDI specialist follows the same routine day after day--arriving at the same time, spending time setting up the day's cases, and making the same rounds--he or she will miss seeing physicians face-to-face or lose the opportunity to review some cases while the patient is still in-house, Krauss says.

"Most people come to work in the morning, hang up their coat, get a cup of coffee, print out the census, look at the records and which patients are new, and look for primary and provisional diagnoses and potential complications/comorbidities," Krauss says. "Then they go upstairs and the doctor has already left."

Krauss says that a CDI specialist should consider the following tips to break out of the routine.

1. Print out the patient census just before you leave for the day Go to the floor to work with the physicians the minute you come in the next morning. "The more time you can spend on the floor looking at records, and the less time in your department, the more effective you will be."
2. Don't start every morning filling out face sheets or DRG worksheets. These are often rehashed summaries of what is already in the record (the history and physical, past medical history, labs, medications, etc.), and can be filled out at different points during the day.
3. Take some time to determine physicians' schedules. This includes determining what time they will be on particular floors with a patient. Adjust your schedule accordingly. "It's not an 8-5 job, there may be some days when you have to come in at 6 a.m., and some days you come in a little later and stay later," Krauss says.

In addition to the other hats they wear, CDI specialists need to think of themselves as business people that run the business of documentation improvement, Krauss says.

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