A: It does require more review. We have not been able to add additional staff members but our current employees are working very diligently within their services. Basically, they have realigned how they look at things.   

We may not see the patient the very first day they’re in, for example. It may be the second day now. And, maybe we don’t perform follow-up queries as frequently as we would like to, although we are working to improve that and we do continue to follow our patients throughout their entire stay.

If a patient has a trach and they are at a SOI level 4 and a ROM level 4, then we will not look at them as frequently as we would otherwise. That decision is left to each individual CDI specialist. While we are unit-based, we also maintain some semblance of service-base; we do cohort our patients. Our CDI specialists have learned their services and have learned how to manage their cases and when they need to do reviews. Because I have a very mature staff they’ve taken it upon themselves to make this work. It has increased our work load.

Unfortunately, we only review our DRG payers. We would like to do 100% review but of course we can’t with our existing staffing numbers. That's probably not the greatest answer but that’s reality and it’s probably reality at some other institutions.

Editor’s Note: Shelia Bullock, RN, BSN, MBA, CCM, CCDS, manager of clinical documentation services University of Mississippi Medical Center, answered this question during the Severity of Illness and Risk of Mortality: Sharpen Your CDI Focus with New Measures of Success audio conference on September 18, 2009.