Comments

  1. Horacio Sosa

    Hello. My name is Horacio Sosa. I am a family-medicine trained Hospitalist in Waco, TX. I work in a privately owned hospitalist group and I am trying to find out if there is an app or resources for a physician like me to ensure my documentation reflect a patient’s status to better match in-patient versus observation status. Example: 101 YOF admitted with suspected LEFT hip fracture. She is demented, possibly delirious, no family at bed side and no documentation from NH. It was felt she probably would simply be placed on hospice, but I admitted her to sort things out and get surgery to see her. Reviewer of my H&P felt she should have been under observation status. Is there a resource that I could pull up to help me guide what I do to help better fit the bill? Thank you for your time.

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  2. Elma Henderson

    Yes, your clinical documentation improvement specialist as well as Utilization review nurses can assist you with ensuring that your documentation accurately reflects the acuity and need of resources for your patient.

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