Sepsis it seems is always in the news, never far from anyone who works in CDI or coding circles. And here we are again, back in the headlines due to its inclusion in the Office of Inspector General (OIG) Work Plan.

Sepsis has been discussed so much due to the complexity of disease, the cost of treatment, complexity of coding, and increased regulatory spotlight. What else is there to say? But with it back in the spotlight I wanted to turn from the usual insular conversations in the mid-revenue cycle to someone working on the front lines of care.

Amanda Hart is an ED nurse and a sepsis clinical nurse specialist at Tower Health, a regional integrated healthcare system based out of Pennsylvania. She spends a substantial amount of time battling this deadly disease, and her work has much to offer anyone who works to get it accurately documented and coded.

On this episode we discuss:

• Amanda’s background in the military and EMS, path into nursing and eventually the ED

• Her role as sepsis clinical nurse specialist and how it overlaps with CDI/coding

• Pathophysiology—clinical indicators of sepsis and what makes it such a deadly disease

• Problems inherent in lack of uniform definitions, what Tower Health uses, and her own take on Sepsis-2 vs. Sepsis-3 debate

• The importance of early screening, including processes, technologies and people. Are EHRs and alerts helping or hindering?

• Tower Health’s home-grown protocol that resulted in a 32% reduction in relative mortality rate in non-POA cases.

• Life on the front lines of care and how it changed Amanda as a person

If you’ve ever been a member of ACDIS you’ve almost certainly encountered Dr. Trey LaCharite’. ACDIS advisory board member? Check. Regular columnist for CDI Journal? Check. Author of the CDI Field Guide to Denial Prevention and Audit Defense? Check. Speaker at the physician advisor pre-conference every year since (at least) 2010? Yes, put a checkmark there, too.

Trey is the Medical Director for CDI and Coding and Clinical Associate Professor for University of Tennessee Medical Center. He’s got the holy trinity of credentials—a MD, plus CCS and CCDS (and others). On this show he brings his unique clinical and coding perspective, combined with real-world applications and trademark tell it like it is/no-nonsense perspective, in a candid interview.

Note: This show was recorded prior to the 2024 ACDIS conference in Indianapolis last week, where Trey presented the session “Beyond Problem Lists: How to Document Is Just as Important as the What.”

On this show we discuss:

• Trey’s path from hospitalist to CDI

• Problem lists: How UTMCK uses them and keeps them updated

• Denials and creating a “defendable narrative” using the patients’ clinical story

• Trey’s opinion on sepsis-2 vs. sepsis-3, now back in the news due to the recent OIG Work List update

• What ACTUALLY resonates with MDs, regarding the eternal question “what’s in it for me”?

• CDI pet peeves, proudest career accomplishment, things to do in TN, and an unexpected OTR playlist addition

Small community hospitals are the backbone of healthcare for most of the country, even today in this era of sprawling healthcare organizations and massive mergers.

But while they’re critical to the health of our nation, resources are often scarce, and CDI is no exception.

Jennifer Cummins, BSN, CCDS, is one of just two CDI professionals covering a 222-bed not-for-profit community hospital in rural Kentucky. Advanced technology and sophisticated AI are not in her toolbox, but that doesn’t mean Jennifer doesn’t take pride in her work.

In fact, she and her colleague are making a big impact with some old-school methods. Their CDI work helped the hospital earn the title of one of the 100 Greatest Community Hospitals in America. Proof that determination, creativity, and teamwork are still more important than tech, even in this day and age.

On this show we cover:

• Jennifer’s origin story—ICU and ER nurse, finding her way into CDI with the help of a nursing colleague

• CDI program--when it began, focus of reviews, and success metrics

• Conducting chart reviews with a basic encoder, books, creativity, and the help of other departments

• Logistical challenges as a small community hospital, including weekend coverage and PTO in a department of two, and rising to meet new initiatives with limited resources

• Expansion to mortality reviews: Identifying the need, process, early successes, and conducting deeper, more intensive reviews

• Fun things to do in Kentucky (aka., Bourbon Trail). Plus Jennifer’s addition to the Off the Record Spotify playlist (Kentucky bluegrass? Find out)