Note from the Associate Editorial Director: Resources for mortality reviews
by Linnea Archibald
It may seem rather macabre to discuss mortality reviews the week before Halloween, but it’s become a hot topic among ACDIS members and CDI friends and bears discussion. In fact, when ACDIS called for submissions focused on mortality reviews for the March/April 2023 edition of the CDI Journal, we received enough contributor articles to include mortality review-specific content in every edition this year.
And the data shows this increased interest too. For example, according to the 2023 CDI Week Industry Survey, more than 31% of respondents review mortalities specifically for denial defense (which of course does not include those individuals who see their work reviewing mortalities as outside the denial defense arena). Additionally, according to a 2023 ACDIS CDI Leadership Council survey, 31.47% make their CDI staff responsible for reviewing all mortalities, and 14.74% have CDI staff reviewing only mortalities that have severity of illness/risk of mortality scores below a four. According to that same survey, the most popular method for CDI involvement is to have the quality team conduct all mortality reviews with occasional support from CDI as needed (37.05%), followed by having CDI second-level reviewers review all mortalities (36.25%).
So, why all this interest now? Well, like most things, the reasons are multifactorial. Of course, as evidenced by the CDI Week Industry Survey data, some CDI teams see this work as part of a denial defense strategy, ensuring that the organization receives appropriate compensation and credit for taking care of mortally ill patients. And, as shown by the Leadership Council survey data, mortality reviews are also deeply entwined with quality measures and focus areas. After all, subpar documentation on mortality charts may lead to the erroneous depiction in your data that the organization and its providers are essentially killing healthy patients.
One thing I heard over and over again during this year’s ACDIS CDI Leadership Exchange that took place last week was that mortality reviews take longer and require more in-depth attention than “traditional” concurrent CDI reviews. The good news is that your experience reviewing complicated mortality cases will inevitably change the way you review concurrent charts for patients who do not expire, therefore improving your expected mortality rate and your observed-to-expected mortality ratio.
No matter why you find yourself reviewing these charts, however, you’ll need specific skills and a new lens to effectively make a difference for your organization. To help you find your way in this complicated review area, I wanted to highlight a few resources available on the ACDIS website you may find helpful (note that I have marked those that are free and open to all and those that are restricted to only ACDIS members):
- 2023 CDI Week Industry Survey for data related to mortality reviews and denials management (free resource)
- 2023 ACDIS CDI Leadership Council survey report on CDI and quality (free resource)
- ACDIS Podcast episode from January 2023 on mortality reviews (free resource)
- CDI Journal articles related to mortality reviews (ACDIS members only):
- “The delicate task of mortality reviews” by Cathy Farraher Nakhoul, RN, BSN, MBA, CCM, CCDS
- “Proving CDI’s, coding’s impact on mortality measures” by JoAnne DNP, MSN, RN, CCDS
- “Developing a mortality review process” by Jennifer Kurian, BSN, RN, CCDS
- “Foray into mortality reviews” by Sarang Shah, CCDS
- “Soul sisters and CDI: Perspectives of mortality reviews from opposite coasts” by Karen Puryear, RN, BSN, CCDS, and Mary Fortunato, RN, BSN, CCDS, CCS
- “Maternal mortality and morbidity: Where CDI can help” by Julian Everett, MHA, BSN, RN, CCDS, CDIP
- CDI Strategies Q&As related to mortality reviews (free resources):
If you’ve still got questions about mortality reviews, feel free to reach out. We’re always happy to help in any way we can. We hope these resources ease some of your mortality review woes this spooky season.
Editor’s note: Archibald is the associate editorial director of publications and membership at ACDIS. Contact her at linnea.archibald@hcpro.com.