Q&A: Short stay patients
Q: What is the role of the CDI specialist in regards to short-stay patients?
A: CDI specialists now work alongside case management staff to educate physicians regarding the 2-midnight rule. Any patient not expected to stay more than two midnights should be placed in observation. If you look at the symptom diagnosis in the DRG Expert, these symptom diagnoses all have a Geometric Mean Length of Stay (GMLOS) of 1.4 to 1.6 days. Therefore, patients with these diagnoses are vulnerable to audits since they do not meet the criteria for admission to inpatient status and they have an anticipated length of stay less than two midnights.
The role of CDI specialist is to examine the record to see if there is a more precise diagnosis or the underlying condition causing the symptom should actually be documented. Therefore, the job is threefold:
- Identify vulnerable short stays and educate physicians regarding placing these patients in observation status.
- Query for any underlying conditions or higher severity diagnoses.
- Examine available resources to identify hospital trends that may place them at risk for audits. These include PEPPER reports for short stays and hospital statistics regarding admissions for high risk diagnoses.
Editor’s note: Sylvia Hoffman, RN, C-CDI, CCDS, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer answered this question. Hoffman is an adjunct CDI Boot Camp instructor and former ACDIS Advisory Board member.