Q&A: Clinical definitions to improve provider support
Q: Have you seen reluctance in physicians wanting to respond to queries related to outcome measures? Certain practitioners seem to avoid mentioning possible severe sepsis, septic shock, and congestive heart failure (CHF) exacerbation to improve specific mortality and readmission numbers.
A: “We haven’t experienced provider resistance for just one category of documentation, related to quality or otherwise,” says C. Dawn Diven, BSN, RN, CCDS, CDIP, CCDS-O, enterprise CDI system director at WVU Medicine in West Virginia.
Instead, Diven found query response rate (or reluctance thereof) is dependent on specific departmental temperament “coupled with a willingness to collaborate and maybe rooted in understanding.”
At her organization, Diven’s team recently began conversations with the quality team and its newly assigned physician advisors around shared clinical definitions (definitions collaboratively developed by stakeholders such as CDI, coding, quality, and physician specialties) which they hope will ultimately lead to system-standardized clinical guidelines. Such collaboratively developed efforts often lead to better engagement due to physician involvement.
The CDI team at the University of California, San Diego, partnered with quality leads and quality medical directors to determine shared clinical definitions. “I think we processed through the four phases of grief,” says Analyn Dolopo-Simon MPH, RN, ACM, CCDS, CDI director there:
- “Anger—It’s coding
- Denial—It’s coding
- Bargaining
- Acceptance—Let’s work on process and agreed upon definitions.”
Now, the UCSD CDI team sits on various quality committees to provide the CDI and coding perspective and helps to funnel important information out to residents, interns, and present at faculty meetings.
“It is a work in process,” she says, “but it has to be done internally with the support of our physicians champions and quality.”
Editor’s Note: This Q&A was part of an ACDIS CDI Leadership Council discussion. To learn more about the Council, click here.