Q&A: Balancing rounding and CDI workloads
Q: We are struggling with finding a good balance between having CDI attend multi-disciplinary rounds and conduct concurrent CDI work. At this time, we attend twice per week, faithfully and then also attend if the CDI specialist feels that they need to speak with a physician who may be in attendance. Some people in management, however, have requested that CDI attend more often.
A: I smiled and sighed because your struggle is a familiar one for most CDI directors. We need to balance the number of activities we’re asked to perform with the actual work of concurrent record review. If we are not completing the task of concurrent record review effectively, then we cannot achieve our mission or focus.
My guess is that management may wish to have your CDI staff there as their participation is of value. When I was working as a CDI, I did try to attend rounds but certainly did not do so every day and often I was sitting in the corner reviewing records and listening with one ear to offer guidance or to ask questions as appropriate. There were days when participation was not very valuable and other days when I was able to capture very valuable diagnoses or indicators to spur a query.
On the other hand, the other attendees often appreciated the presence of CDI in these meetings. We were able to communicate the working DRG which clearly allowed determination of the geometric length of stay, quality triggers, etc. We also seemed to be a great resource of what exactly was happening with the patient (as we are often the only individuals who read the entire record). The CDI specialist was seen as a wonderful resource for information.
The issue for you, is to weigh the advantages earned as compared to the time lost in record review. I am unsure how long these rounds take at your facility—are they performed on every unit? I would suggest you compute the time involved first. For example, if they take one hour every day per unit by week’s end, ‘X’ hours are spent in meetings and in that time we could effectively review ‘X’ number of records. Depending on the size of the hospital and the time spent this might allow for increased staff members. If you are told to participate, I would track your productivity and identify if there is a significant decrease in the number of records reviewed.
The struggle that most CDI departments find is that because we offer value to almost every endeavor (DRG assignment, CC/MCC capture, quality scores, medical necessity, risk adjustment, etc., etc.), everyone wants our time. In some ways, your success can be your biggest hurdle.
Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CDI Education Specialist at HCPro in Danvers, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit www.hcprobootcamps.com/courses/10040/overview.