Guest Post: CDI as chart traffic control

by Wendy Frushon Tsaninos, RN, MSTD, CCDS, CMSRN, CCS

One of my favorite occupational movies is Pushing Tin. Its take on air traffic control is from before 9/11, and just to make it more interesting, it stars actors familiar to the Gen-X population (John Cusack, Billy Bob Thornton, Angelina Jolie, and Cate Blanchett). Of note, the dialogue includes a tongue-in-cheek observation: pilots don’t actually land the planes—the air traffic controllers do.

This sarcasm reminded me of what happens with the medical chart—no matter what the providers write (and despite what diagnoses are still “up in the air”), CDI specialists are there to guide the chart to where it needs to land…hopefully without a “crash and burn” moment. Here are a few ways in which we do that:

• Present on admission (POA) clarification: Just as a pilot needs to request permission to take off, we must also request information such as POA in order to properly assign a working DRG. Putting a diagnosis that wasn’t POA in the principal diagnosis spot can be akin to a flight path headed toward Spokane when you thought you were going to San Diego. You’ll wind up in the wrong place.
• Consistency in documentation: Planes pass through various airspaces during longer flights, with handoffs between air traffic controllers (see one example at A Flight Across America – FAA). Safely landing the plane depends on smooth transitions. In patient care, lengthier patient stays can mean that several providers from different service lines will be documenting in the chart. Despite the electronic medical records’ copy and paste functions, charting can be like the whisper game…what was said at the beginning comes out distorted at the end. CDI specialists keep the chart on the path to appropriate and compliant coding and billing. This can even mean querying retrospectively when the discharge summary is missing key diagnoses.
• Case mix index (CMI) improvement and recover audit contractor (RAC) audit-proofing: – An air traffic controller has several airplanes to navigate on his or her scope. They are keenly aware of airport and airspace traffic. CDI specialists are also privy to environmental information, such as which providers are consistently documenting symptoms instead of diagnoses and which diagnoses are being further scrutinized by the RAC for clinical validation. With our bird’s eye views, both air traffic controllers and CDI specialists strategize for efficiency and optimal outcome. An air traffic controller aims to get more flights to arrive on time and safely; a CDI specialist strives to increase the CMI through educating providers and clarifying diagnoses without clinical support.
• Allowing for “flexibility within the form:” Sometimes, an air traffic controller has a high volume of aircraft in the airspace at one time. This can mean that one or more planes need to “take a spin” in the sky before being lined up for approach to the airport. CDI specialists also must demonstrate this flexibility in terms of diagnoses. Patient condition and timing of documentation and diagnostics will sometimes require us to be patient and wait until the next day to place a query. Ebb and flow is important in both positions.
• Participation in safety initiatives: One statistic quoted in the film is that an air traffic controller is in charge of more lives in a shift than a surgeon is in his or her entire career. There is only a certain amount of “near misses” allowed in air traffic control (under three in a two and a half year period, according to the movie) before a controller is pulled from the job. Health care providers are also under scrutiny for never events and hospital acquired conditions, and CDI specialists place queries to help with PSI and HAC documentation.

Although one of the requirements to become an FAA air traffic controller is to enter the FAA Academy before your 31st birthday (oh, how that ship has long ago sailed!), it’s still possible to practice chart traffic control from the comfort of your facility by being a CDI specialist. It can be a thankless, “unseen” job, but in both air traffic control and CDI, things run smoother with us than without us!

Editor’s note: This article was originally published and written by Wendy Frushon Tsaninos, RN, MSTD, CCDS, CMSRN, CCS, Lead Clinical Documentation Improvement Specialist at Maxim Health Information. Connect with her on LinkedIn by clicking here.