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Neurology and Neurosurgery: Clinical & Review Criteria Guidelines for Managing Care, 2nd Edition
Apollo Managed Care Consultants, May 2011, Pages: 235
The events related to medical and surgical procedures lend themselves well to the application of guidelines, protocols or pathways to assist in understanding the medical/surgical care issues that either require an acute hospital level of care or that will lead to an increased length of stay (LOS) at an acute level of care. Many procedures that until recent years were routinely performed following inpatient admission are now performed in ambulatory surgery suites or in ‘day surgery’ programs. An openness to consider whether a procedure needs inpatient care at all is really the first step in the resource utilization management evaluation process.
It is recommended that, for any common surgical procedure where the LOS is greater than expected, a day by day or shift by shift evaluation of the care delivered with an analysis of its medical necessity and adequacy be developed.
Some of the common factors that tend to prolong LOS for surgical patients that are not directly related to the specific procedure include:
1. Pre-operative factors
a) patient preparation as an outpatient
b) admission the day of surgery
c) patient expectations for LOS and events during the hospital care period of time
d) Discharge planning at or prior to admission.
2. Characteristics of the patient
a) Age
b) Family/significant other support and availability to provide care
c) Availability of required home care services in the community
d) co-morbid conditions (e.g., diabetes or congestive heart failure)
3. Complications related to the procedure(s) or multiple procedures
4. Foley catheter removal
5. Pain control - adequacy
6. Ambulation
7. Nutritional intake - oral
8. Fever evaluation and management
9. Use of home care or SNF services
10. Failure of the hospital system to provide needed services in a timely manner. (e.g., weekends tend to be down times for many needed radiology, lab, therapy and other services.)
11. Failure of the rounding physician to discharge at an appropriate time.
This report covers evidence-based clinical and review criteria guidelines for outpatient and inpatient tests and procedures with indications, medical necessity coverage criteria, authoritative references and resources. In addition it includes alzheimer disease & ADHD page clinical guidelines, both with extensive references and resource materials.
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