ACDIS tip: The intersection of PSI and CDI

by Karla Accorto

According to the World Health Organization, adverse events resulting from unsafe care is likely one of the top 10 causes of death and disability in the world. In fact, experts estimate that one in 10 patients in high-income countries experiences an adverse event while receiving care in a hospital, up to 50% of which are preventable.

These are two of the facts with which Sharme Brodie, RN, CCDS, a clinical documentation improvement (CDI) education specialist for HCPro, began a recent presentation concerning patient safety indicators (PSI). As someone new to the CDI world, I was admittedly confused as to what PSI had to do with CDI—I could see how patient safety and CDI efforts were both important, but the relationship seemed initially unclear to me. So, I began by attempting understand what exactly a PSI is.

Generally speaking, PSIs provide information on potentially avoidable safety events that represent opportunities for improvement in the delivery of care. Commercial payers may require organizations to hit certain PSI benchmarks, and state agencies use PSIs in their reporting of quality of care to further drive transparency in healthcare. And CMS uses PSIs to calculate reimbursement rates for hospitals as part of its Hospital Value-Based Purchasing program, which rewards hospitals that provide high quality care with higher reimbursement rates.

The less adverse events an organization experiences, the higher the quality of care provided. Theoretically. Sometimes, whether a PSI gets reported depends on the documentation, I learned.

PSIs are risk-adjusted and incorporate diagnostic-related groups (DRG), so CDI efforts can make a difference, and this is where the effect of a CDI specialist became clear to me. Since CDI staff ensure the accurate capture of principal and secondary diagnoses, their efforts often illustrate whether a condition truly qualifies as adverse outcome. In reviewing the documentation for factors such as principal and secondary diagnoses, complications/comorbidities, major complications/comorbidities, and present on admission indicators, the CDI specialist plays a crucial role in capturing the complexity and acuity of a patient.

Additionally, the ACDIS/AHIMA 2019 Practice Brief Guidelines for Achieving Compliant Query Practice, states that CDI specialists may review prior encounters to aid in forming a query for the current encounter. For example, if a patient presents with a stage two pressure ulcer but previously presented with a stage four pressure ulcer, the CDI specialist can create a query to clarify whether the correct diagnosis is a stage two pressure ulcer or a stage four that is healing. The ability to look back on a patient’s prior encounters reflects the evolving nature of the profession—as technology has advanced, allowing for ease of access to medical records by making them available electronically, CDI specialists have learned how to make the most the information at their fingertips.

However, Brody cautioned CDI specialists about acting on information just because it is readily available and advised in her presentation, “When in doubt, cover thyself and query.”

Editor's note: The information in this article was derived from a PROPEL CDI presentation. Accorto is a PROPEL CDI member liaison. Contact her at kaccorto@hcpro.com.