Note from the Instructor: Celebrating critical thinking in CDI

CDI Strategies - Volume 14, Issue 12

by Laurie Prescott

As a child I always loved working on puzzles. As I grew older, they became larger, more complicated. I haven’t touched a jigsaw puzzle in years, but puzzles don’t always come in a box. The process of record review is a puzzle. The CDI specialist reviews the record and strives to connect all the pieces. We note what pieces are missing and work to capture the true picture of the patient’s health status and the encounter.

Just like when I’m sorting through a box, sorting edge pieces, colors and shapes, comparing my work to the big picture, a record review requires the same process. It requires critical thinking. It requires sorting through the facts and piecing them together to create the complete picture.

We talk about critical thinking all the time (or at least I do). What does it mean? Can one learn to think critically? Can we teach others to think critically?  

I define critical thinking as thinking about one’s thinking, challenging one’s thought process, opening the mind to identify what is not easily seen. Critical thinking means constantly questioning, constantly looking for answers. Asking questions is what we do—critical thinking is a core function in CDI practice.

Although some are better critical thinkers than others, this is a learned skill. Critical thinking requires experience. It is a matter of expanding your perspective, repeated exposure allows one to experience a specific circumstance differently with each review. We learn that although diagnostic criteria appear to be black and white and not flexible, each patient will present uniquely, each encounter is different. We learn what questions to ask, what labs to review, what medications are significant, what symptoms require a deeper dive. We learn with every record, every review.

I often see CDI professionals critiquing the work of their coworkers and sometimes not so kindly pointing out one’s lack of critical thinking. Such critique often leads to the third question mentioned above: Can we teach others to critically think?  My short answer: of course you can. As we discussed, critical thinking requires one to apply their previous experience to a new situation and question the facts, search for the relationships, complete the puzzle.

If you are an experienced, critically thinking CDI professional, you can teach others. Instead of being critical of their performance, model the process. Ask the questions out loud so that observers can hear the wheels turning inside your head. Sit at the puzzle table with new CDI specialist, explain what you’re doing while you sort through the pieces. Share your experience, be a leader in your profession. Share the skill of critical thinking, pass it on to others. It makes us all stronger.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, CDI education director at HCPro in Middleton, Massachusetts, answered this question. Contact her at For information regarding CDI Boot Camps, click here.

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