Journal excerpt: Keep an eye on the periphery

As with any new review area, CDI teams can choose to focus on a variety of diagnoses within the Vizient risk adjustment model. CDI programs benefit most, however, from picking a manageable number of diagnoses, to maximize priorities. At a large academic medical center in the northeast, the CDI team originally focused on sepsis, stroke, and COVID-19 (though they’ve now ceased reviewing stroke predictors), says one CDI specialist there.

When choosing a focus, it can be easy to put on blinders to all other potential documentation issues. CDI efforts can’t catch everything all the time, but if staff notice a documentation issue in the chart, they shouldn’t  ignore it just because it doesn’t fit neatly into the team’s focus areas. Doing so can leave a mess for others to clean up later in the workflow (such as the DRG validation team).

For example, a project focused on sepsis Vizient measures, could cause the program to  missed  COVID measures.

If the volume of cases being reviewed for Vizient predictors gets overwhelming, it’s a perfect opportunity to collaborate with colleagues in other departments and ask for help. For example, the DRG validation team could send post-discharge queries to help capture some of the predictors that may not have been caught concurrently. This ability was especially useful at the height of the COVID-19 pandemic, at the northeast academic medical center. Many COVID-19 charts had long lengths of stay, requiring reviewers to comb through pages and pages of documentation.

Collaborating with peers in other departments—such as those who conduct post-discharge DRG validation or quality-specific reviews—will help ensure that missing documentation doesn’t slip through the cracks. While it would be ideal for CDI to catch every opportunity on the front end, that’s sometimes unrealistic due to incomplete documentation at the time of the review.

Editor’s note: Read this full CDI Journal article here.