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Vol 26, Issue 4

Emily Sturkie, MD Associate Chief, Clinical Operations at Hillsborough

  • Hillsborough Updates 1

  • Coding Corner 2

  • Hospitalist Highlight 3

  • Back-to-School Photos 4

UNC Division of Hospital Medicine

Hospitalist Happenings

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Hillsborough Updates

GI is back!

We are happy to have GI consults again available at Hillsborough campus. They have improved their staffing model with one attending covering consults for each week. As previously, their services are only available Monday-Friday from 8am-5pm. You can reach them through the directory (listed under the same grouping at GI/hepatology for UNCMC). It is important to note that some patients will still require transfer to UNCMC depending on their clinical stability and primary problem.

Major exclusion criteria include:

  1. Unstable GI bleeds
  2. Decompensated cirrhosis
  3. IBD with acute flare
  4. Esophageal foreign body/food impaction
  5. Fulminant C diff
  6. Severe ascending cholangitis

If in doubt, you can discuss the case with the GI fellow to determine the best location for admission.

Looking for the consult list?

The availability of consult services is often in flux at Hillsborough. There are some services that have different ways of requesting a consult. There are two major ways you can access the most up-to-date information about the availability of consult services at Hillsborough:

Follow this link Consult Service Availability to find a Google doc that has specific hours for services as well as quick tips for each service

To look up the list from Epic, you can use the dot phrase created by the UNC Family Medicine service .fmishbrconsultavailability

You can also find this information and more on the DHM Sharepoint documents

Coding Corner

When documenting AMS, think dementia, delirium, and encephalopathy.

Why Documenting Delirium and Encephalopathy Matters

  • Delirium and encephalopathy are more than clinical diagnoses -they're key documentation elements that affect patient care, severity of illness, hospital outcomes, and reimbursement.

Clinical Importance

  • Delirium: Acute, fluctuating disturbance in attention/awareness, often signaling underlying illness.
  • Encephalopathy: Global brain dysfunction from a specific cause (delirium caused by a specific insult: toxic, metabolic, structural, or systemic.)
  • Both are patient safety priorities linked to falls, prolonged LOS, and readmissions.

Quality & Reimbursement

  • Delirium is a CC (Complication and Comorbidity) that will increase the CMI (Case Mix Index) and hospital reimbursement by ~150%
  • 'Metabolic Encephalopathy' and 'Toxic Encephalopathy' are MCC's (Major Complication and Comorbidity) that will increase the CMI (Case Mix Index) and hospital reimbursement by ~200%
  • Clear documentation supports accurate quality metrics (LOS index, mortality index, CMS and US News rankings) and helps justify inpatient admission.

Documentation Tips

  • Use specific, definitive language: 'Toxic -metabolic encephalopathy due to sepsis' or 'Toxic encephalopathy secondary to cefepime.'
  • Define the patient's baseline vs. current state: 'At baseline A&Ox1 -2, but conversant, bright, and able complete some ADL's at her memory care facility. Now, no responding to questions, poor eye contact, and unable to complete and ADL's or follow direction.'
  • Avoid vague terms like 'confusion' or 'AMS'.

Paul Ossman, MD, MPH Lead Physician Advisor for Clinical Documentation Integrity

Mike Contarino - Sept. 7th

Amy Dacillo-Curso - Sept. 12th

Hospitalist Highlight

Katie Butler

'I was born and raised on the coast in South Carolina, studied architectural history at the College of Charleston, and worked in the Emergency Department in Virginia before attending medical school. You've probably seen me around during my time here at UNC for all the things - med school, med/peds residency, and pediatric (PHM) fellowship - excited to be staying on as a med/peds hospitalist!

My husband, EJ, has spent the last decade working in operations/management roles for Under Armour, and we have two young kids and two golden retrievers. Like most we love the college basketball atmosphere here, but you can more often find me at the UNC Women's Soccer games and supporting the NC Courage. When the weather's nice, I am out running (slowly) on the Tobacco Trail or adventuring to fun parks and trails with our kids & dogs. I am the only person from my Northeast rooted family to be born in the south so love all things Yankees baseball and believe good bagels from NJ are worth overnight shipping (though Brandwein's is solid!). Excited to work with you all!'

Upcoming DHM Faculty Meeting

Noon -1:00 | PECR3 & Webex

August 27th: Opportunities for AI w/ Michael Neuss

No Operations Huddle on 9/1

Hospitalist Happenings

Wishing all of our little scholars a wonderful start to the school year!