Case study: CDI education through audits
For Mariclare Hoffmann, RN, BSN, CCDS, director of CDI at UC Health in Aurora, Colorado, audits—or, what her department refers to as “assessments”—are strictly intended to “focus on the education and individualized support of the CDI specialist.”
“The goal,” Hoffmann says, “is to make sure we can ensure a high level of competency, compliance, as well as quality. We’re always focused on supporting the CDI specialist: Whether they’re struggling to write their queries, providing enough clinical evidence, or just finding opportunities, we customize our education to whatever the needs of the specialist are.”
At UC Health, conducting audits is the responsibility of the CDI educators. In Hoffmann’s department, this task is split between one lead educator and three auditor/educators under the direction of one quality and education supervisor.
According to Hoffmann, UC Health has two audit types. The first is a “comprehensive audit,” which is “top to bottom, including queries, clinical evidence, and missed review opportunities.” For new hires, this audit occurs at six months and again at one year. After the first year, all CDI specialists are audited annually.
“Those [comprehensive audits] are the ones more focused on query compliance, making sure are practices are standardized, and making sure that our newly onboarded CDI specialists are moving at a good pace and acclimating to the UC Health workflow,” Hoffmann explains.
With this type of audit, there is a score threshold that the CDI specialist must cross in order to pass (currently 85%). CDI specialists who fail to meet the threshold are given continuing education support until they are able to achieve a satisfactory score.
On the rare occasion when a CDI specialist is unable to demonstrate the desired improvements, they are placed on a performance improvement plan. But even this term, according to Hoffmann, is misleading.
“What it really means is that we will go back with them, review everything top to bottom, and do over-the-shoulder reviews with them. This way, they have real-time feedback. We would do this for several months before we would consider terminating an employee. We truly have assessments focused on the educational support and individual growth of the CDI,” Hoffmann says.
The second type of audit is a “missed query” audit. These are, Hoffmann says, “purely educational” in orientation: “It’s just for another opportunity for someone else to come up behind the CDI specialist and point out if they missed any query opportunities and provide some constructive feedback. There’s not even a score associated with those.”
Editor’s note: This is an excerpt from “‘It’s really not what you think’: CDI education and audits,” in the July/August 2025 edition of the CDI Journal.