tion in the EHR. The working DRG and GMLOS entered into
the EHR appears on the case management and physician’s
patient list. The GMLOS is shared with the care team to work
towards a discharge date.
This evolving workflow to incorporate an up-front CDI review
process has generated additional questions and education for
physicians based on the DRG. It also supports Piedmont’s strategic initiative to improve length of stay and throughput for
patients. Shorter stays result in fewer complications—driving
better patient safety and quality outcomes.
DRG Team Details
Piedmont’s second team of specialists comprise the DRG team
and are responsible for ongoing CDI assessments. As in most
CDI programs, these staff review cases during the inpatient
stay, continually update the working DRG, confirm that admitting diagnoses are correct, and note complications and
comorbidities (CCs) and major complications and comorbidities (MCCs). These specialists take on 10 new cases every
morning from the admission review team based on priority;
six high-priority cases and four medium- to low-priority cases.
The DRG team includes more advanced CDI specialists
who focus on clarifying clinical documentation in the EHR
and compose direct queries to Piedmont’s medical staff.
While the workflow for this team has not changed significantly since moving to the all-payer program, its efficiency
and results have improved with the support of up-front admission reviews.
For example, before adding admission reviewers, the team’s
query rate averaged 13 percent. Since changing the workflow
to initiate up-front CDI reviews, the query rate now averages
between 20 percent and 25 percent. The new process also expedites overall CDI efficiencies as the admission review team
ensures the right cases are promptly placed in the hands of the
DRG reviewers, eliminating any delays in clinical documentation assessments.
Staffing Considerations for Expanded CDI Program
Additional CDI staff are needed to support any CDI program
expansion, as it is essential to have the current number, educational level, and experience level of staff. While Piedmont’s
staffing model continues to evolve, the following five steps
were taken to ensure success:
Offered remote work options for broader hiring flexibility
Incorporated the use of outsourced CDI staff to provide at
least t wo specialists per hospital
Rotated staff so each hospital has at least one CDI specialist on site daily
Staffing, Workflow Evolves
with Move to All-Payer CDI
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