Guest post: The challenges of physician education

By Laurie L. Prescott RN, MSN, CCDS

The biggest challenge of being a CDI specialist in my opinion is the education of the physicians. They fly by us like stealth bombers and we have limited face-to-face time to make the impression. Fortunately, the snippets of education we do provide during those brief interactions can be our most valuable tool. So, I try to be ready because I might only get 30 seconds to explain why his or her confirmation of a present-on-admission indicator is so important with a sepsis diagnosis or why we are interested in knowing if the sepsis developed from the dialysis catheter or from pneumonia.

At the end of the day I take an unofficial “inventory” of these conversations and begin to identify other means of getting the information to the physicians.

At my facility, we developed many methods to reach our physicians. We created “doc-u-tips” (little letters we put in their mailboxes on specific subjects) and we include documentation improvement articles in their monthly physician newsletter. We hang posters in their lounge and place them in clear sleeves in the charts to explain documentation guidelines for diagnoses such as respiratory failure and chronic kidney disease.

Drawing from my experience as a nurse educator, I try to follow the mantra “seven times, seven ways,” meaning if you wish to communicate a message you must disseminate the information at least seven times in seven different ways. I once had a physician tell me that you could train a dog with seven repetitive steps but it will take you 21 years to train a physician. I told him that I am too old to wait 21 years for success!

CDI specialists have to face the challenge of how to identify our physicians’ educational needs and we need to know how to best “package” and “present” our education while ensuring it the information is reliable, based on established clinical criteria. As most experienced CDI professionals well know, physicians are more accepting of the information presented if it comes from their own literature and uses their own established critical guidelines. Sourcing this information to their professional organizations gives me credibility. It shows that I am just not just telling them what we need for coding purposes but asking them to document to the standards established by their own profession.

Lastly, I try to avoid speaking about coding guidelines or what “I need them to say” merely in an effort to accomplish my own job. I encourage them to tell the patient’s story, to provide specific and complete diagnoses, and to provide the diagnostic criteria to support their conclusions.

There are times when I will explain where a specific term will lead in regard to DRG assignment but I try to avoid these comparisons. If I supply them with definitions or diagnostic criteria that explains and supports specific wording of diagnoses they appreciate that. For example, the old challenge of urosepsis versus sepsis. I can explain how ureosepsis will code to a urinary tract infection or I can provide them with the diagnostic criteria of SIRS- showing how their patient meets this diagnosis based on the criteria. This method shows them the meaning of the word(s)/documentation and shows how their choice relates to the patient’s clinical condition.

The ACDIS website and library provides many examples of how our colleagues are meeting these challenges of physician education. I have always felt no need to reinvent the wheel. For example Tiffany Estes, RHIA, CCDS, at UNC- Chapel Hill shared her Physician Documentation Handbook in the Forms & Tools Library. With her permission I am in the process of adapting it for my medical staff. The library is a great way to share information.

Please, let’s expand this conversation: What methods have you found the most effective in reaching your physicians? Where do you find your sources? How do you identify educational need? What “wins” have you been able to celebrate? Do you have a specific challenge you need help with?

I am sure there is someone reading this blog right now that would benefit from your successes or might lend advice to your challenges.

Editor’s Note: Prescott, at the time of this article's original release, was a CDI specialist at Morehead Memorial Hospital in Eden, North Carolina. She had more than 25-years’ worth of nursing experience having received her BSN from the University of Vermont and her MSN-ed from the University of Phoenix. She has worked in many aspects of nursing to include med-surg, peri-anesthesia, ICU, nursing administration and nursing education, and began working as a a CDI specialist in 2007.