Note from the Associate Editorial Director: Consistancy and the swimming pool

by Melissa Varnavas

Hypothetical question: You don’t know how to swim, but you’re learning. You have an inner tube around your waist. Now, where would you rather continue your lessons–in the pool in your backyard or in the ocean?

A friend of mine posed this question to me a long time ago. We were discussing the philosophical importance of creating respectful boundaries (a set of concrete rules) in which to raise children. Of course parents will always want to support their children regardless of situation or peril. The inner tube represented that type of support. But he argued that he’d rather learn how to swim in a pool, because the boundaries were obvious (the edge of the pool) and the water clear, free from any hidden dangers (like sea serpents or sharks). Within that realm, he suggested, children could feel comfortable learning the basics–the doggie-paddle per se–of how to navigate in the world. There they could perfect their skills and advance, perhaps even to the breast-stroke, before jumping into the open ocean.

I was reminded of this anecdote when reading a tip Lynne Spryszak, RN, CCDS, CPC-A, CDI education director for HCPro, Inc., in Danvers, MA, wrote for the December 23, 2010 edition of CDI Strategies. She recommended that facilities develop a uniform set of policies and procedures to govern query development and dissemination for everyone regardless of what department originates the query or houses the CDI program. She said:

“Everyone should be querying using the same criteria, whether they’re nurses, coders, or physicians. Number one: It makes your practice consistent. Number two: It makes life easier for everyone.”

In its Guidance for Clinical Documentation Improvement Programs, AHIMA stresses the importance of developing policies and procedures. It states:

“The CDI department must be governed by written policies and procedures. These policies and procedures should be developed with the assistance of other departments affected by clinical documentation, including compliance, case management, and HIM.”

The world is a chaotic place, was the point my old friend attempted to make. We lean on our parental love, guidance, rules, and yes even societal regulations to help make us feel safe. In adapting the analogy to CDI policy and procedure development it seems simple to say that a consistent message from hospital leadership regarding physician queries can help eliminate some of the chaos that competes for physicians’ attentions and coders and CDI specialists best intentions. But it’s like Lynne says: “It makes like easier for everyone.”

If you haven’t yet developed a set of query policies and procedures for your program yet, take a look at the ACDIS Forms & Tools Library or the AHIMA guidance for some samples.

Editor's note: Varnavas is the associate editorial director of ACDIS. Contact her at mvarnavas@acdis.org.