Q&A: Structuring a CDI specialist's work day
CDI Strategies, July 24, 2008
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Question: How do you set up your typical work day? Are there any effective patterns for live communication vs. reviewing charts and electronic records? How flexible should a CDI specialist be?
Answer: I begin a typical work day by printing out the daily unit censuses. Each nurse then creates a worklist from our electronic worksheet/database. Before going to the floors, we check for any outstanding queries for patients who were discharged the previous day. We follow up with any open or unanswered queries by calling the physician directly, faxing a copy of the query to the physician’s office, or, when necessary, we make arrangements to meet face-to-face with the physician to discuss the patient record.
We expect CDI specialists to spend the majority of their day on the units to provide the maximum opportunity for interaction with physicians and other clinical staff. Specialists obtain information from the EMR while they are on the unit, and this is where they also complete the worksheet and assign a working DRG. As the CDI specialists develop familiarity with physicians, they also learn how to communicate with them most effectively. Physicians who tend to ignore written queries in the chart may receive an additional communication. For example, we may leave a message with their office manager requesting a return call at the physician’s convenience. When the physician returns the call, we ask him or her to address our written query during the next patient rounds.
When a CDI specialist is on the unit and a chart is unavailable or the patient is off the floor, the specialist can plug the EMR information into the worksheet and analyze and incorporate the information from the actual chart into the worksheet the next day or later in the day, as time allows. Specialists also make notations on the worksheet. For example, they may document the following:
- "Need CC or MCC"
- "Check primary diagnosis again; may need query"
- "Watch for procedure"
- "Check operative report to determine whether a query is necessary".
The CDI specialist needs to build flexibility into his or her schedule to allow for meetings, lunch, working on special projects, etc.
(Lynne Spryszak, RN, coordinator, clinical documentation management program, Alexian Brothers Medical Center in Elk Grove Village, IL, answered this question.)
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