The Elusive Staffing Formula

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CDI leaders have been contemplating the same challenging question since CDI programs first appeared in health organizations: how many FTEs do we need to adequately staff our CDI teams?

Electronic medical records have given health organizations greater access to data and the ability to take on more complicated functions. Despite the advantages that come with the implementation of electronic records, many CDI leaders continue to struggle with identifying the optimal number of positions needed.

There are an increased number of documentation requirements necessary to identify conditions being monitored and treated. Quality of the outcomes also requires a deeper level of documentation that needs to be considered when reviewing a record.

Ideally to capture documentation specificity and accuracy, all records should be reviewed daily. But realistically, who has the staff to cover every chart every day?

There are many formulas that have been created attempting to identify appropriate coverage, spanning from 1100 to 3200 discharges per CDIs. Often, the coverage goal is arbitrary and changes over time based upon identified payer mix and expected depth of chart review.

When there are more factors to consider, the cases take longer to review, decreasing the total number of cases that can be realistically reviewed per FTF. Analysis for patient safety indicators (PSI) adds significant time to a record review.

A definitive answer for determining staffing levels for CDI programs does not exist with current methodologies. There cannot be a one-size-fits-all solution to identify appropriate staffing for CDI programs.

How can this problem be managed so that CDI programs have the support they need? Instead of reacting to inconsistent variables, CDI leaders should look to redefining the metrics of their CDI programs.

The goal should be to review 100% of the right cases every day.

The “right” cases are the cases that have opportunity for documentation improvement. Only these cases should be reviewed for accuracy and specificity in documentation for medical necessity, quality measures, severity of illness, risk of mortality, and changes in clinical status.

With more efficient record reviews, CDI teams can leverage their existing staff and start saving one of their most valuable resources: time.

The right technology makes it possible for teams to find the right cases, empowering leaders to create a model for staffing that accurately reflects the volume of CDI reviews needed.

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