Kansas City Regional CDI Meeting Minutes

Kansas City Regional CDI Meeting Minutes

Wed., April 27, 2011 at St. Mary’s MedicalCenter,Blue Springs

Members in attendance: Sarah Hoyt, Tara Kreiling, Denise Miller, Kathleen Daniels, Peg Merker, Linda Ball, Johna Brill, Debbie Cooper, Meri Beth Jackson, Joann Agin, Vici MacLean, Jeri Nell Stephens, Lynne Gregson, Carol Hiller, Faith, Pharr, Roberta Schibi.

Joann Agin chaired the meeting. She reported that she emailed Melissa from ACDIS to see when we could have another audio conference.

Two Heartland CDIs who had gone to the National Conference in Orlando were in attendance. They reported at National, there was much emphasis on querying and also on dealing with non-compliant doctors. Most speakers were doctors. There was a recommendation at National that the words “expected” or “unexpected” be used on anemia queries.

There was discussion about coding incidents that might be an expected part of a particular diagnosis or procedure. Joann reminded us that if an incident occurs that is a normal or expected part of a diagnosis or procedure, it probably shouldn’t be coded, e.g., an ileus that occurs within the first couple days of a major surgery would be expected.

The Heartland CDIs said National also recommended each hospital develop criteria for standards for diagnoses, so that everyone is on the same page.

Johnna asked if anyone else is doing core measures; this has been added to their duties. They are under Nursing. Some of the other hospitals in attendance also have CDIs doing core measures, some don’t. Bothwell, in addition to core measures, also is required to look at nursing documentation related to core measures. Consensus of the group was that core measures were best done concurrently, and best done by staff not doing CDI or UR.

Denise asked how CDI nurses communicate queries without a paper chart, esp. with Cerner. Some hospitals with Cerner mentioned that Cerner has a “message center”: a query can be written and sent to a specific physician. It can be set up to be a permanent part of the chart, or not. Linda suggested Denise volunteer at her hospital to do a 30-day trial of the message center.

Denise asked about pulmonologists who write acute resp failure for most of the open-heart patients, to increase their E&M, even though the pt has been weaned from the vent in the usual amount of time. She is querying to ask if it really was resp failure. Joann said the physicians should be made to realize that they may be opening themselves up to an audit.

The question was asked if RACs are appearing at the hospitals and what they are focusing on. Answers from the group: They want one-day stays to not be In Patients, even if they meet criteria for in patient; medical necessity; charts with one MCC; malnutrition; BMI; and sepsis.

Joann encouraged the group to use email amongst ourselves and to use CDI Talk.

Tara asked if anyone is sharing ROM/SOI with physicians. Heartland is looking at programs to do this. Joann said Premiere Data is supposed to be able to do this, but what she has done is to run reports to show physicians DRGs in relation to ROM and LOS. Someone mentioned Hospitalcompare is supposed to be starting to show data on individual physicians.

Sarah asked if anyone wears lab coats. She has been noticing increased respect on the units on days when she wears a lab coat. Most of the CDIs can wear a lab coat as an option, none required it. Several routinely do wear lab coats; NKC said some do, some don’t in their group.

Denise mentioned CDI nurses go to physician orientation at their hospital to talk about their CDI program, and she has noticed increased compliance amongst these doctors. NKC is going to have a CM/CDI in their ED to help catch documentation about ulcers, foleys, etc.

Linda asked if anyone has done a fair. No one responded in the affirmative. Linda’s hospital had a Fair for the different hospital departments and thought it would be good for CDI to have a booth, or to have a station at competency/skills days.

Next meeting: July at Shawnee Mission. They will decide time and date. The group likes the audio conference and also likes the open discussions. The next meeting could have informal presentations from National Conference attendees about things they may have learned, and also open discussion. Joann may present info from an ICD-10 conference she will be attending.

Minutes submitted by Vici MacLean, RN, DIS, St. JosephMedicalCenter