UM Guidelines
Ambulatory Surgery Complications: Observation Care

Inpatient and Surgical Care (ISC)

BCBST modification effective June 14, 2014*


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 2014.
  1. Gupta, A. (2009). Preoperative screening and risk assessment in the ambulatory surgery patient. Retrieved June 3, 2014 from https://www.google.com/search?hl=en&source=hp&q=gupta+preoperative+screening+and+risk+assessment+in+the+ambulatory+patient&gbv=2&oq=gupta+preoperative+screening+and+risk+assessment+in+the+ambulatory+patient&gs_l=heirloom-hp.3...969.25031.0.25844.69.15.0.54.54.0.141.1216.14j1.15.0....0...1ac.1.34.heirloom-hp..45.24.1216.y1Hco-gjCWA.

 

 

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