Tis the season: CDI skirts working major holidays

Many CDI specialists coming from the bedside nursing background are used to working weekends and holidays. It comes with the territory—hospitals are open 24/7, 365 days a year, and doctors, nurses, and the like have to be on-site at all times. Those transitioning to the CDI field do so for a number of reasons, including a more flexible schedule. But when it comes to working on major holidays, is it necessary for CDI specialists to be on the clock?

 

The initial response to the idea of working the holidays was shock, says Juli Bovard, RN, CCDS, CDI specialist at Rapid City Regional Hospital in South Dakota, questioned the rationale.

 

“When we come in on Mondays [or after a holiday], we have a CDI specialist who reviews and completes all the reviews for the discharged patients from the weekend [or holiday],” says Bovard. “I can almost guarantee [the cases] would not be coded by then.”

 

There is no such thing as a documentation emergency, says Katy Good, RN, BSN, CCDS, CCS, CDI program coordinator at Flagstaff Medical Center in Arizona. At her facility, CDI staff do not work weekends or major holidays.

 

“We catch all of those charts regardless,” says Good. “Queries can wait one [or two] days.”

 

Anna Rozhkovskaya, RHIT, CCS, CCS-P, manager of CDI at Memorial Healthcare System in Miramar, Florida, says her facility used to work holidays, but created a policy giving CDI specialists major holidays off.

 

The concern for many managers is productivity, but for record reviews, queries, and other CDI duties, working weekends and holidays may not be necessary to get the job done, says Renee Meyer, RN, CCDS, a CDI specialist in northern California. Her hospital observes seven holidays annually, and CDI specialists also get weekends off. “[Even with the days off,] we have a review rate of over 90%,” she says.

 

Even with weekends and holidays off, LeeAnn Conaway, RN, CCRN, CCDS, CDI coordinator at UPMC Altoona in Pennsylvania, says her staff still has a high review rate. “The small percentage of records we miss will be reviewed by our coders and, if they see an opportunity, they have a CDI review it and ask a question post-discharge,” says Conaway. “The rest of our queries are done concurrently.”

 

The major holiday season marks the end of the year, and while this is often a busy time for hospitals, the census for many facilities usually drops, says Karen Bridgeman, MSN, RN, CCDS, CDI educator at Medical University of South Carolina in Charleston.

 

“By the time the actual holiday arrives, our census will usually drop significantly between Christmas and New Year’s,” she says.

 

At Flagstaff Medical Center, Good noticed the same thing—the census is lower around the holidays. During this season, productivity remains unchanged, with a review rate of 98%–100%.

 

 “Honestly, I think for the hospital, financial impact should be considered as well,” says Good. “Paying staff holiday pay when the same outcomes could be attained without this added cost is certainly a factor.” If productivity is an issue, CDI specialists should come up with a plan to ensure reviews will be completed, says Kay Blue, RN, BSN, ACM, director of CDI at the Carolinas Healthcare System in Charlotte, North Carolina.

 

Her CDI team does not work the three major holidays—Thanksgiving, Christmas, and New Year’s Day. They make sure to provide a minimum of 50% CDI staff coverage the day before and the day after each holiday.

 

At least one person is required to work the other holidays during the year, Blue says, though that has not been an issue. “Sometimes staff prefer to work the holiday to avoid traffic, or because a spouse is available to care for the kids,” she says.

 

It’s also a good idea to keep track of reviews missed during weekends or holidays, so CDI can prioritize when they come back to the office. “We review all payers, and we do have a discharge without review list that is monitored for reviews [older] than one day,” says Bridgeman.

 

The CDI staff can collaborate, too, when it comes to scheduling days off around the holidays. “Our team is generally happy to cover other team members so that everyone can have a couple extra days off,” says Good.

 

At many facilities, the CDI position is considered a privilege for seasoned professionals because the work does allow for flexibility. Many consider holiday time off and flexible schedules a perk of the job, says Conaway.

 

“We require at least five years of critical care experience [for our CDI specialists], and our least senior person has 15 years,” she says. “As far as I am concerned, not working weekends or holidays is one of the benefits of being offered a CDI position.”