Karolyn Skudlarek, RN, and the CDI staff at St. Cloud (MN) Hospital have performed reviews of OB/ newborn documentation since they started the CDI program in February 2008.A 489-bed facility (average daily census of 307 beds), St. Cloud employs three CDI reviewers.
It’s the end of the year, and many of us have been on the fast track to EHRs and EDMS installation, so we pause this month for a little levity and to honor all those working so hard behind the scenes. Happy holidays to all the brave...Read More »
by Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS
I work at a small community hospital with less than 100 beds. We implemented an emergency department (ED) case management (CM) model that focuses on weekday admissions during regular business hours. We’ve trained the ED nurse...Read More »
by Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS
Communication is defined in the Merriman-Webster dictionary as a verbal or written message, exchange of information, or a process by which information is exchanged between individuals through a common system of symbols, signs,...Read More »
by Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS
A clinical documentation improvement (CDI) specialists’ focuses on educating physicians on the merits and material benefits of complete, accurate, and effective medical record documentation on the practice of medicine.Read More »
A recent hospital audit of 300 medical records turned up some not too surprising facts about physicians. The doctors are still not documenting appropriately, their handwriting is illegible, and the discharge summaries are inadequate.Read More »
