Q&A: Resources for new hires
Q: I am interested in learning about the resources that other programs utilize for new hire orientation. Our current orientation program is comprehensive and well-structured, primarily involving one-on-one educational sessions. We use online modules from Nthrive Education to provide a general introduction to CDI, coding rules, distinctions between MS-DRG and APR-DRG, as well as details pertaining to each major diagnosis category (MDC). I am curious about the electronic modules or webinars that are commonly employed by other programs for similar purposes.
Response #1: We do not use an electronic model; however, we use an intensive classroom experience in the first year for our CDI specialists that lasts about two weeks long. This would be a few months after the initial orientation which is about eight weeks long. This gives the new specialists time to apply what they have learned in orientation and then work on translating these abstract skills into practice. There is such a steep learning curve for novice specialists that we have found this timeframe works best and is not as overwhelming.
Response #2: Our new hire orientation is conducted by our level II CDI specialist or CDI coordinator, both of whom have up to three new team members at a time. We use a virtual Microsoft Teams platform as we are an all-remote workforce. We focus our education on the normal workflow for CDI specialists through our 3M 360 program and supplement/support this education with a targeted MDC (or set of categories). We then assign the MDC to be reviewed via Nuance University and show how that area/category is found; or, through a record review, what elements the specialist should look for and how to query.
Additionally, we use our own curated educational library of PowerPoints—e.g., acute kidney injury, acute tubular necrosis, anemia/bleeding related conditions, cerebral edema/coma and Glasgow Coma Scale, congestive heart failure, depression/drug dependence, dysrhythmias, functional quadriplegia, HIV, myocardial injury, patient safety indicators (PSI), sepsis—as well as our health system’s policies and education materials regarding organizationwide consensus statements and internal diagnosis definitions. Finally, throughout the education process, we reference ACDIS and AHIMA for best practices, query compliance, and utilize the resources in the 3M 360 program and the 3M Library.
Response #3: Our orientation process for our new CDI specialists is about 10-12 weeks long and is a combination of online training modules, which utilize the ACDIS HCPro PROPEL boot camps, and one-on-one hands-on training conducted by our educators and/or managers. We try to have new specialists jump into cases sooner rather than later and try to have them apply the boot camp knowledge on a daily basis. The orientation is 100% remote through Microsoft Teams. After the 10-12 weeks, they go to campus with a seasoned CDI specialist to learn the landscape of the campus, as well as good provider interaction. Our team is hybrid with one to two days a week onsite.
Response #4: We are a 14-hospital system with a total of 52 specialists. We review all payers, and our team is under the quality umbrella, so we also focus on quality metrics such as PSI, complications, hospital-acquired conditions, hierarchical condition categories, in addition to the normal CDI review.
We identified a dedicated team member who excels at educating and orienting new team members and leverage her talent to train and onboard new CDI specialists. When we have a new member, she is temporarily taken out of productivity/chart review to provide dedicated orientation training and preceptorship to our new recruits. We have promoted her to CDI level II with additional compensation since she functions on a higher level and has created lesson plans/orientation plans formally.
We recommend keeping it to two to three recruits to maintain a more personable approach (but she could potentially handle more people as needed!).
We use a combined approach through a series of modules online provided by a vendor and a chart review of correlated topics. The modules review specific MDCs and common diagnosis strategies for CDI specialists. We look for marching records with assigned DRGs based on the review modules, so that we can associate the module content to real life cases.
Our team functions entirely remote, so the orientation is also online entirely. The response rate is 95+% and the agreement rate at 84+%. We have cut down orientation from 10-12 weeks to six weeks with this method, and our newbies are kicking it out of the park! The review process is systematic with templates to help new team members share how they are reviewing the record and their thought processes. The chart review is done in a specific order with head-to-toe assessment of EHR content. I’ve been told they love it too!
We have lesson plans daily and team members start reviewing their own records after two weeks of training and enter the preceptorship period for four weeks. The educator remains elbow-to-elbow and the team shares case reviews in the afternoon. By the end of the training, the CDI specialist ought to function independently, possessing the ability to identify gaps based on systematic review, and illustrate satisfactory knowledge of coding/guidelines/query principles, as well as the 3M 360 software (we are Cerner based EHR).
Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council and originally appeared in the CDI Leadership Insider, the monthly council-only publication. For the purposes of this article, all Council member answers have been deidentified.