Q&A: Missed opportunities in mortality reviews

Q: What are some ways to assist with mortality reviews in order to identify missed opportunities and increase the severity of illness (SOI)/risk of mortality (ROM) scores for the case?

A: One thing to help ensure you are not missing any opportunities is to create a second-level CDI review process that’s carried out by either a dedicated CDI specialist or the team lead.

If you have the bandwidth to do so, try looking at all mortality records prior to billing. This will help ensure you are capturing the highest SOI/ROM scores possible for each case, before it goes out the door.

If you can’t review all mortality charts, try using benchmarking tools to identify cases where you are above the expected mortality rate. You can then use this information to audit for opportunities throughout the record review process.

It may be helpful to focus on only mortality cases that did not reach a 4/4 score for SOI/ROM; this will help narrow your focus and provide the most bang for your buck.

If you come across any discrepancies or unclear documentation, query the attending physician. If the physician pushes back, escalate the issue to a physician advisor for review if you have one, or follow your organization’s escalation process.

Editor’s note: This question and answer were adapted from a thread on the ACDIS Forum. To learn more about the retrospective review process (including mortality reviews), click here. To learn about how mortality reviews and publicly reported quality data intersect, click here.