Health Information Management

Director’s Note: ACDIS Radio Offers News and Insight

CDI Strategies, October 23, 2014

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Yesterday I hosted our second installment of “ACDIS Radio.” During the call I was joined by ACDIS Advisory Board Member Walter Houlihan, MBA, RHIA, CCS, director of HIM and CDIatBaystate Health in Springfield, Massachusetts, Vicki S. Davis, RN, CDI manager for Cone Health-Alamance Campus in Burlington, North Carolina, and more than 400 participants.

Although only 37% of participants said their programs track “observed-to-expected” (O-to-E) mortality outcomes, Davis explained how she and her CDI team worked in conjunction with its quality counterparts to focus on improving the O-to-E rate at her 238-bed community hospital.

“In the beginning I had no idea what ‘O-to-E’ meant, but I worked with our quality department and quickly learned how this information tied directly to our work with severity and risk of mortality,” Davis says. “All the documentation and all the codes work together. It isn’t about capturing a single code or single DRG when you look at this measurement. The sicker the patient is, the more comorbidities they have, the greater the expected mortality rate becomes.”

The observed mortality rate at a facility is the actual number of expired patients in a given time period whereas the expected mortality rate is the number of patients, given their conditions and comorbidities, at risk of expiring during the inpatient admission.

“Your facility’s expected mortality rate should always be higher than your actual, observed, mortality rate,” Davis says. “You don’t want more people to die at your facility than expected.”

When her CDI program launched in 2010, however, its O-to-E ratios seemed to show just that. Today, the data shows that less than half of those expected mortality actually occur. Capturing secondary conditions, complications and comorbidities, and examining the entire medical record for documentation improvement opportunities all contributed to the improvement. Focus areas included malnutrition, sepsis, hypokalemia, and liver failure, among others. And Davis’ team reviews every record for every inpatient mortality looking for documentation missteps and opportunities for improvement.

At Cone Health improving patient health and reducing mortality rates represents the “crème-de-la-crème” of achievements, so when Alamance leaders honored Davis and the CDI team for their achievements it was “exceptional,” Davis says. “We’d talked to other CDI programs about our efforts and we felt very strongly about our success but it was terrific for our own system to recognize our work.”

We think so too and congratulate Davis on her efforts and hope that those participating on the call gleaned some tips and inspiration for their programs

The next ACDIS Radio call takes place Wednesday, November 5, at 11:30 a.m., ET. Please sign up and listen in. Talk to you then!



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