Health Information Management

Tip: Pediatric CDI expansion may be easy as 1, 2, 3

CDI Strategies, May 9, 2013

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If you are considering expanding your CDI program to include review of pediatric records, consider these three tips:

Tip #1: Blaze your own trail. The majority of today’s CDI programs address the adult patient population and tend to focus on Medicare regulations and reimbursement, says Valerie Bica, BSN, RN, CPN, CDI specialist at Nemours/A. I. duPont Hospital for Children in Wilmington, Del., and leader of the ACDIS pediatric/NICU network. However, there are children who receive Medicare health benefits. Pediatric hospitals may want to consider hiring a consultant to jumpstart their programs simply because of the lack of literature available, she adds.
However, ensure that the consultant has experience with pediatric CDI. For example, CDI specialists in a pediatric hospital shouldn’t be querying for oliguria (low output of urine) because it is a meaningless symptom in most pediatric patients. Instead, they should be asking questions such as:
  • What’s the cause of the oliguria?
  • How severe is the situation?
  • Is it mild dehydration?
  • Is it acute renal failure?
  • Is the child obstructed or septic?
These questions are much more important than the fact that visualized urine output seems low.
Tip #2: Let physicians lead the CDI effort. Allowing physicians to lead the effort—rather than become targets of it—will help ensure physician-buy in, says Robert S. Gold, MD, founder and CEO of DCBA, Inc., in Atlanta, Ga. The one caveat to this is that geriatric medicine shouldn’t be directing education for neonates and pediatric diseases and operative reports, he adds.
Tip #3: Focus on quality—not reimbursement. Identify and clarify missing, conflicting, or nonspecific provider documentation. The goal is to ensure that severity of illness and risk of mortality accurately reflect the complexity of patient care provided, says Bica.
“The children who come into our hospital are medically complex in many ways. They’re seen by a multitude of providers. We wanted every service line to be clear on what the comorbid conditions were for every child,” she says. “We feel that the CDI program can help to make sure that anyone who opens that chart in the EMR can be instantly aware of all the problems that the child suffers from.”
Editor’s note:This article originally published on, and was presented during HCPro’s audio conference, The Pediatric Medical Record: Opportunities for Documentation Improvement.

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