Q&A: Updating the problem list
Q: Do your CDI staff members update the problem list? If so, do you have a policy or protocol that you are willing to share?
Answer #1: We do update the problem list in Epic if we have an agreed query. We also provide an overview message, such as “Query answered by Dr. XX” with the date and time in the problem list note.
Answer #2: My department started a quality improvement project back in 2020, and it is now being implemented in another area within the hospital regarding the problem list. The CDI program does not have the authority to update or make changes to the problem list. We developed a “problem list” query, however, that is very easy to read and answer for most providers, such as, “Dr. J, it is noted the patient is being treated for aspiration pneumonia as evidenced by XYZ, can you please add to the problem list if you are in agreement?” CDI efforts are impacting the problem list this way, just not without providers doing the work.
Answer #3: At my organization, CDI specialists do not use the problem list. We have been asked in the past if we could update it, but we have declined, as these are medical diagnoses and we feel it is out of scope (practicing outside RN license) for an RN working in a CDI role.
Answer #4: At our facility, it is the responsibility of the clinicians who attend to the patient to keep the problem list updated. The CDI specialists are not responsible for this task, although we do ask the clinicians to update the problem list as query responses are presented. This keeps the problem list updated appropriately with fewer hands touching the chart, which keeps accidental or error documentation from being introduced into the medical record or on the wrong patient.
Answer #5: At my facility, CDI specialists do not have access to update or change the problem list, but I have been on a task force group over the past few years that built a policy around our problem list and did a quality improvement project for one of our inpatient units around improving the accuracy of the problem list. That project had a few different processes such as education, reminders, and weekly huddles that were somewhat of a success. We ended up developing a problem list query, which is a very straightforward query asking providers to add and/or remove a diagnosis based on the documentation within the narratives. This has been a big success and we improved our accuracy at discharge to 90% without adding a lot of extra steps to our current review process. The problem list is certainly a problem, but one I believe should be worked on as it’s a communication tool for our patients.
Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council.