Note from the ACDIS Director: Finding purpose, post COVID, within the CDI profession

by Brian Murphy

I had a great couple of days this past weekend. The weather up here in northeast Massachusetts, some 35 miles north of Boston, was in the low-mid 80s. I spent Saturday afternoon outdoors with my father, 77, and my wife and daughters, barbecuing and chit-chatting. One dose of Moderna has been in my body for more than three weeks, and the next comes tomorrow, Friday May 28. I’m happy, ecstatic, that the world is getting back to normal.

But beneath that elation is the reminder of what we just went through, and the scars that we bear—if not physical, then spiritual. Accumulated fatigue, a feeling of a dodged bullet when I look at my dad, who suffers from several comorbid conditions that would have put him at significant risk had he contracted COVID-19. A sense of guilt that others did not fare as well as I did.

Many CDI professionals are feeling the same.

We had a great conversation about this subject on a recent episode of the ACDIS Podcast: Talking CDI.  One of my guests, Autumn Reiter, RN, BSN, CCDS, CCDS-O, CDIP, CCS, a bedside ICU nurse before moving into CDI and consulting, described the feeling as survivor’s guilt. “’Why am I better than everybody that’s struggling, and dealing with this horrific sight at bedside? Why do I not have to deal with that?” she asked. “Then you hear about people who lost family members or can’t go home because they’re afraid of bringing it [COVID] home.”

Co-host Laurie Prescott (CDI education director at HCPro) mentioned not being able to sleep at night. Reiter thought about returning to patient care in the midst of the crisis. Fellow guest, Erica Remer, MD, CCDS, did as well, pitching in by helping to perform vaccinations.

“I felt really impotent and anxious,” said Remer, who contracted the virus in March of last year. “I used to break out crying, periodically, just feeling so helpless. If our listeners had a similar feeling of helplessness, they should know they were not alone.”

Those feelings took a toll on mental health, and reawakened feelings of returning to patient care throughout the profession. According to a poll we asked on the show asking whether listeners missed working at the bedside, 8% said yes, regularly and/or acutely, a full 50% said somewhat/from time-to-time, and 31% said no (11% not applicable).

But CDI professionals can make a difference, in their day-to-day work of chart review. Their efforts to ensure accurate and optimal reimbursements helps hospitals pay for PPE and ventilators and other critical, life-saving equipment. And their work cataloguing the record of disease helps with understanding the spread of the virus, as well as which patients are the most vulnerable for ventilation and/or death.

“I’ve been very fortunate that my path has let me help people in a different way,” Reiter said. “First and foremost, ICD-10 codes were meant for data collection. What we are doing is making sure that the most appropriate code is assigned to that patient, and in turn that data can be used to determine treatments that are most effective—how do we keep patients out of the hospital. Our role is helping patients get better care. It’s just in a different way than a lot of us are used to. We’re just not there holding that patient’s hand anymore.”

Remer agrees. “Identifying quality of care issues is totally in the CDI wheelhouse,” she said. “If we find issues of HACs or patient safety indicators, I feel really strongly that people should not be doing contortions to try to desperately get them erased from the record. Sepsis is a good example. We see it all the time—patients who they didn’t recognize had sepsis early enough to intervene, or at all. The organ dysfunction went unnoticed. If we can help our systems get sepsis right, we can really have a tangible impact on improving patient care.”

Let me be clear: Not all CDI professionals are nurses or worked at the bedside. HIM professionals with extensive coding experience comprise a goodly portion of our CDI community. And they too need to know how their work helps with the communication of patient care, work that in turn can improve diagnosis and treatment.

I am not a doctor, nor do I play one on television. But I feel a small sense of pride having helped to foster this wonderful community, whose job is, at heart, to ensure that the severity and acuity of a patient’s conditions are reflected in the health record.

While I encourage you all to allow yourselves time to handle the emotions resulting from the pandemic, I hope you also take time to really take pride in the work you do, too.

As May, Mental Health Awareness month, draws to a close, I urge you to think about your higher purpose in this wonderful profession. It can help you stay mentally healthy in your day-to-day work, knowing that you have made a difference in the chain of healthcare, and more importantly, in people’s lives.

Editor’s note: Murphy is the director for ACDIS. Contact him at bmurphy@acdis.org.