Australian woman brings CDI 'down under'

At ACDIS, it’s no surprise when we hear about clinical documentation improvement efforts extending to hospitals and organizations throughout the United States. But when we heard about an Australian hospital launching a CDI program—one of the first international programs of its kind—we were beyond excited.

Nicole Draper, RN, BN, MHA, is the woman spearheading the efforts at her facility in Darlinghurst, Sydney, Australia. As the manager of length of stay, documentation, and revenue optimization, she works to address and alleviate documentation challenges. Using ACDIS resources and networking with CDI specialists in the United States, she was able to launch a pilot program for the first-ever CDI program down under.

Draper, married for five years to her husband Drew, an attorney, has two boys, James, 3, and Charlie, 2. In their free time, her family enjoys an outdoor lifestyle and takes advantage of living close to beautiful beaches. She also enjoys cooking and hosting barbecues and dinner parties, going to the park with her kids, and traveling.

CDI Journal: What did you do before entering CDI?
Draper: I completed my bachelor degree in nursing in 1994 and my master’s degree in health administration in 2004. I am currently pursuing a doctorate in health with a research focus on clinical documentation. Prior to getting into CDI, I was a nurse manager in the perioperative environment for 16 years.

CDI Journal: How long have you been in the CDI field?
Draper: I have been in the CDI field for 18 months. Currently, I work at St. Vincent’s Private Hospital Sydney, which is the oldest private hospital in Australia. It is located in Darlinghurst, quite near the city and the iconic Sydney Harbor Bridge and Opera House.

My title, manager of length of stay, documentation, and revenue optimization, is a newly established role with one of the focuses being documentation. In my new role, I was seeking ways to address the challenges around documentation, particularly medical staff documentation. In our facility, we are paid in one of two main funding models: case payments based on Australian Refined Diagnosis Related Groups (AR-DRGs) or a per diem method. In a case payment environment, documented patient complexity results in a higher reimbursement from the health funds.

A large portion of our work is funded in this way. We knew because of our high patient complexity and a longer length of stay in some specialty areas compared to our peers that documentation was sometimes insufficient, and thus we were not being reimbursed appropriately.

CDI Journal: Tell us about your experiences building a CDI program in Australia.
Draper: I began researching to look for ways to improve our documentation and found ACDIS. I immediately joined and attended the 2015 conference in San Antonio. I returned bursting with ideas and post-conference energy.

On returning, I met with our HIM manager and director of nursing and clinical services to discuss the benefits of a CDI program. From there, we developed a proposal to undertake a nine-month pilot CDI program. We identified two specialty areas based on length of stay and patient complexity, and went to the hospital executive and the nursing executive to seek approval, which I was given. The two areas we are concentrating on are neurosurgery and general surgery, which includes colorectal, upper gastrointestinal series, and vascular.

We established a steering committee and [recruited] two experienced clinical nurses to undertake the CDI specialist role, who began training on January 11, 2016. We are working closely with 3M to provide the training, modifying the CDI modules for the Australian market.

CDI Journal: What are some of the differences between CDI in Australia and CDI in the United States? Draper: The DRGs in Australia look different than those in the United States. For example, a knee replacement without complications is an I04B, and with complications is an I04A. A hip replacement is an I03B, spinal fusions I09B, and craniotomy B03B. Incidentally, Australia has been on ICD-10 for about 10 years.

CDI Journal: What has been your biggest challenge?
Draper: We’re very lucky, because the hospital executive and medical staff support the program and its aims. I imagine once the program is up and running, we may face some challenges. We’re trying to be prepared and have been engaging our medical officers early to ensure the program is successful.

CDI Journal: What has been your biggest reward?
Draper: Meeting individuals who are so generous with their time and support in helping us start a CDI program from scratch.

CDI Journal: Can you mention a few of the “gold nuggets” of information you’ve received from colleagues on “CDI Talk” or through ACDIS?
Draper: The CDI Roadmap for establishing a CDI program has been invaluable, along with the policies in the Forms & Tools Library.

CDI Journal: What piece of advice would you offer to a new CDI specialist?
Draper: The ACDIS groups are warm, welcoming, and willing to share their experiences. So, join and become part of it.

CDI Journal: If you could have any other job, what would it be?
Draper: This job is exactly where I want to be. I have the flexibility to be with my family, drive a program like this, look for innovative ways to improve and contribute to patient-centered care, and be at the forefront of something that is quite new in Australia.

CDI Journal: What was your first job (what you did while in high school)?
Draper: I worked in a kiosk at Caves Beach, where I grew up. I think I was paid $20 a day—and that was on top of ice blocks and hot chips!

CDI Journal: Tell us about a few of your favorite things.

• Vacation spots: My brother and his family live in Columbus, Ohio, and I have visited at least eight times. When you live so far away, you have to make the most of your holidays by seeing as much as you can. Door to door, Sydney to Columbus is 24 hours! Last Christmas, we traveled through Europe, which was wonderful. The Greek islands are also a favorite.
• Hobby: Going to the beach, reading, and making and decorating cakes.
• Non-alcoholic beverage: Sparkling water with a dash of lime.
• Foods: Thai, Indian, and Italian.