Note from the CDI Education Specialist: Adopting a collaborative mindset in CDI

by Nicole Nodal-Rodriguez, MSN, RN, CCDS

So many times in my career as a CDI specialist, there have been opportunities that arose almost by accident. What I mean by this, is that often an “aha moment” or job-related improvement happened when working alongside other departments that were also trying to reach the same end goal.

In the field of healthcare, it is easy to get comfortable in your own department and create a silo while working toward daily productivity. During my time as a CDI specialist (and as a nurse in general), I’ve learned that we spend hours upon hours duplicating efforts and processes. There isn’t enough emphasis placed on the role of collaboration between CDI and other departments or the impact it has on an organization’s success. This is particularly challenging now with many CDI programs working remotely.

Heart failure documentation is a great example of an opportunity for collaboration, which can have a positive impact on healthcare organizations and overall representation of the acuity of this patient population. This diagnosis and other Hospital Readmissions Reduction Program measures are very important due to their impact on hospital readmission rates.

Some examples of collaboration potential include:

• Partnering with providers to educate regarding documentation accuracy during onboarding, residency, and regular education so that heart failure specificity is understood, documented appropriately, and the reason for the admission is clearly documented. Not only are your teams providing education, but they are building relationships.
• Teaming up with interdisciplinary practitioners including dieticians, wound care specialists, and provider specialists can provide the opportunity to educate on the components of a patient’s condition that should be documented to support the severity of their illness.
• Connecting CDI and heart failure coordinators to review readmission rates and missed opportunities, and set future goals for improvement from both patient care and documentation perspectives.
• Working with coding to ensure the diagnoses documented are captured accurately and sequenced to support the patient’s clinical picture and treatment provided. This can be as simple as a hard stop on encounters with conditions included in the HRRP like heart failure to be reviewed by both coding and CDI departments before they are final billed and coded. This is particularly important when there is a question over the selection of the principal diagnosis. For example: was the focus of the admission really heart failure to begin with, or was it actually an end-stage renal patient in fluid overload due to missed dialysis?
• Providing monthly CDI metrics to administration to reflect impact (e.g., medical necessity, provider performance, length of stay, denials outcomes) and then creating action plans resulting from this data.

As you can see, CDI is primed to impact many areas of an organization. Collaboration is key. Get out of your silo and go build some bridges!

Editor’s note: Nodal-Rodriguez is a CDI education specialist at HCPro. Contact her at Nicole.Nodal-Rodriguez@hcpro.com.