Journal excerpt: CDI efforts affecting the special care nursery

By Cathy Farraher, RN, BSN, MBA, CCCM, CCDS

At a recent meeting, my facility coders discussed that our special care nursery (SCN) patients were an outlier for length of stay (LOS). This surprised CDI staff—the reputation of the unit was very good, so how could it be an outlier?

At that time, CDI staff did not perform reviews on the SCN population. [So,] I asked my supervisor if she would allow me to see if I could help with the problem. Finance provided a report noting the following types of cases:

• Cases with a LOS of 21 days or more with an APR-DRG weight of less than 3.0
• Cases with a LOS of 14 days or more with an APR-DRG weight less than 2.0
• Cases with a LOS of 7 days or more with an APR-DRG weight of less than 1.0

My first step was to meet one-on-one with the department chair. During our meeting, I provided a real-time look at a scenario being grouped, then explained the corresponding LOS associated with the final APR-DRG, as well as the same situation with some additional severity diagnoses added. Not surprisingly, she asked if I could present to the entire team as soon as possible.

Our lead coder came with me …[and we] provided the physicians with specific examples of cases that were documented as usual and compare them with the same examples documented with the specificity and acuity recommended by CDI professionals, and let them know how this affected their patients’ expected LOS.

There were a few questions regarding our query process—a few comments along the lines of “We weren’t taught this in medical school...”—but aside from that, the group was ready and willing to run with what I offered.

Acute respiratory failure received quite a bit of discussion. Several of the physicians were adamant that they did not allow their patients to succumb to respiratory failure. When asked what they were treating when they provided CPAP or intubated a newborn, they all agreed that they were treating respiratory failure, as well as preventing it from becoming more severe. (Read an ACDIS white paper on pediatric respiratory failure here.)

Editor’s note: This article is an excerpt from the May/June edition of the CDI Journal. Farraher is a CDI specialist at Newton Wellesley Hospital in Newton, Massachusetts. She was a member of the Massachusetts ACDIS chapter’s leadership team and is currently serving as co-chair of the CDI Practice Guidelines Committee. The opinions expressed do not represent a consensus agreement of ACDIS or its Advisory Board. Contact her at cfarraher@partners.org.