Concurrent review nurses

[helpnhands]

Could someone please tell me what this job entails in plain English please? What kind of skills are good for this job? Someone told me I'd be good at this because I'm pretty good with computer skills and figuring out things from the patient charts. Is that true?

What is Interqual? Do I need it? How do I learn that?

[jjjoy, LPN]

I don't know about Interqual, but here is concurrent review as I understand it...

There may be certain benchmarks that a facility is trying to meet... such ASA prescribed on discharge for all AMI patients unless otherwise contraindicated.

Hospitals want to measure if they are meeting this goal, so they might hire someone to review all AMI charts and find out if ASA was prescribed on discharge. However, if the reviewer finds that ASA wasn't prescribed, there's no way to fix it. The patient didn't get their ASA on discharge (or it wasn't documented that they did) and the hospital didn't meet it's goal.

So instead, the hospital may hire someone to concurrently review AMI cases. That is, they track AMI cases and review the chart while the patient is in the hospital. If they find that the patient is about to be discharged but that ASA wasn't prescribed, they can make sure that it IS prescribed or that it's documented why it wasn't prescribed.

So a concurrent reviewer has a dual role of collecting clinical data and participating either directly or indirectly in patient care. You can see why nurses are popular in this role. NPs are especially valuable because they can just write the scripts or document contraindications themselves, as opposed to the nurse, who must get a physician (or NP or PA) to document treatment choices.

Functionally, then, a concurrent reviewer will be juggling whatever relevant cases are currently in the hospital, having to stay on top of the care in order to check on the benchmarks they are responsible for. The patients may be in various units throughout the facility and of course there are several different people that must be coordinated with in real time to ensure benchmarks are being met. So the reviewer may spend a lot of time tracking down patients, patient charts and other care providers. They will also likely have deadlines for organizing and submitting any data they've been collecting to whatever review body is interested in that data (CMS, hospital QA dept, etc). Which is where the computer skills come in.

I think concurrent review is the best way for hospitals to meet such benchmarks, but it's labor intensive. It takes a lot more time and effort to concurrently review cases and take an active role in the patient's on-going care than to review them after the fact. And that costs money.