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UM Guidelines
Ambulatory Surgery Complications: Observation Care

Inpatient and Surgical Care (ISC)

BCBST last reviewed September 21, 2016*


Added:
   

Observation Care Admission Criteria

An Observation may be appropriate for 1 or more of the following:

  • Unstable vital signs: blood pressure and pulse not within 20% of preoperative baseline with ALL of the following:
    • IV fluids as appropriate
    • Evaluation for possible surgical complications
    • Close monitoring of vital signs until stability achieved
  • Patient who is not alert, or has a mental status either abnormal or not at baseline with ALL of the following:
    • Possible arterial blood gas (ABG)
    • Evaluation for possible surgical complications
  • Abnormal temperature: patient either febrile or hypothermic with temperature inappropriate for outpatient treatment of condition) with 1 or more of the following:
    • Evaluation for malignant hyperthermia if febrile
    • Evaluation for possible infection if febrile
    • Warm patient up from postanesthesia hypothermia
  • Inability to ambulate or to achieve appropriate activity level postprocedure with 1 or more of the following:
    • Evaluation for possible surgical complications
    • Assistance with ambulation until ability returns (as appropriate)
  • Operative site is u nsatisfactory with 1 or more of the following:
    • Excessive postoperative bleeding, inconsistent with expected blood loss for the procedure for 1 or more of the following:
      • Transfusion if necessary
      • Control of bleeding locally and evaluation for re-operation
      • Observation until bleeding is consistent with expected blood loss for the procedure
    • Excessive postoperative drainage, inconsistent with expected drainage for the procedure (e.g., replenish fluids if necessary)
  • Postoperative effects with 1 or more of the following:
    • Excessive pain, uncontrolled by oral analgesics if ALL of the following:
      • Parenteral treatment until level of pain is acceptable to the patient
      • Subsequent management with oral analgesics
    • Excessive nausea and vomiting uncontrolled by oral medication if ALL of the following:
      • IV fluids and electrolytes
      • Parenteral or rectal treatment until patient has adequate oral intake
      • Subsequent control with oral medication

Observation Care Discharge Criteria

  • Discharge to non-acute-care follow-up is appropriate for a patient with ALL of the following:
    • Vital signs stable
    • Mental status at baseline
    • Afebrile
    • Able to ambulate
    • Operative site satisfactory
    • Pain controlled

References

  1. BlueCross BlueShield of Tennessee network physicians. August - September 2016.
  2. Gupta, A. (2009). Preoperative screening and risk assessment in the ambulatory surgery patient. Retrieved June 3, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/19633545.
  3. Mathis, M. R., Naughton, N. N., Shanks, A. M., et. al. (2013). Patient selection for day case‐eligible surgery: identifying those at high risk for major complications. Anesthesiology. Retrieved August 12, 2015 from http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1918045.

 

 

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