Radio Recap: Expanding CDI to the outpatient observation setting

CDI specialists reviewing outpatient observation records are “essentially playing the clinical detective,” said Seth Kirschner, senior manager at the Claro Group, LLC, in Chicago, on the April 19 episode of ACDIS Radio, “ACDIS conference preview: Expanding CDI to the outpatient observation setting.”

Though there are many different outpatient focus areas CDI can choose to review, observation provides a straightforward entry point into outpatient record review, said Kirschner. Much of the process for observation reviews proves similar to the inpatient reviews which typically fall under the purview of CDI specialists.

“The scope mirrors that of an inpatient documentation specialist,” said Lori Sackela, RN, CCM, CCDS, regional director of CDI at Mount Carmel Health System in Columbus, Ohio, on the April 19 program. “The person in the role should be very motivated and someone you consider to be a top performer on your team because the job in observation is very fast paced,” Sackela added.

Of course, there are some differences between observation and inpatient. Besides the fast paced nature of the environment, the CDI specialist reviewing in the observation setting also needs to take a collaborative approach with case management, Sackela said, and review their notes too.

“When we do find a patient who may actually belong in inpatient, CDI communicates with case management and, if needed, may also query the physician,” she said.

CDI specialists reviewing observation records may also interact with utilization review (UR). Though at first glance, this CDI specialist’s responsibility may look like it overlaps with that of the UR staff, Sackela sees them as quite distinct.

“We don’t educate the documentation specialists to become experts in the admission criteria that case management use. Instead, really what we’re focusing on is reviewing the record in an effort to determine if an experienced documentation specialist can see the case differently than a case manager or a UR nurse would,” she said.

There are already a number of invested parties reviewing the observation records—case management, UR, physicians—and CDI specialists need to bring fresh eyes to the task, said Sackella.

“One of the most difficult things is to look at that medical record and not agree with the physician,” she said. A CDI specialist brings a different set of skills to the table, which contributes to making the whole record as accurate as possible.

Even with the slightly different short-term aim, tactics, and timeframe, the CDI specialist’s end goal when reviewing observation records is the same as every other area of CDI purview: complete and accurate documentation for each patient.

“I usually suggest that CDI specialists in the observation setting really focus on obtaining the appropriate documentation to support the patient status and then any other documentation that can support acuity once they are an inpatient,” Kirschner said.

These focuses, of course, also translate to the correct status for the patient, improved patient safety, and proper reimbursement.

“I was hopeful that if CDI became involved in looking at the medical record and began working well with case management, we could ultimately have a positive impact on the patients we serve and our hospital by simply ensuring that we are getting the record right,” Sackella says.

Editor’s note: To listen to the complete April 19 episode of ACDIS Radio, click here. Kirschner and Sackella are also presenting at the 2017 ACDIS Symposium: Outpatient CDI, September 18-19, in Oak Brook, Illinois. To find out more and to register for the event, click here.