Ambulatory Surgery Complications


	UM Guidelines

Inpatient and Surgical Care (ISC)

BCBST modification effective September 18, 2009*

Added:

A 23-hour observation may be appropriate for ANY ONE of the following:

ALL of the following for a patient with Unstable vital signs (blood pressure and pulse not within 20% of preoperative baseline):

IV fluids as appropriate

Evaluation for possible surgical complications

Close monitoring of vital signs until ASDC met

ALL of the following for a Patient who is not alert, or has a mental status either abnormal or not at baseline:

Admission for more postanesthesia recovery time

Possible arterial blood gas (ABG)

Evaluation for possible surgical complications

ANY ONE of the following for a patient with an Abnormal temperature (patient either febrile or hypothermic with temperature inappropriate for outpatient treatment of condition):

Evaluation for possible infection if febrile

Warm patient up from postanesthesia hypothermia

ANY ONE of the following for a patient Unable to ambulate or to achieve appropriate activity level postprocedure:

Admission for more postanesthesia recovery time

Evaluation for possible surgical complications

Assistance with ambulation until ability returns (as appropriate)

ANY ONE of the following for a patient with an Unsatisfactory operative site:

Excessive postoperative bleeding, inconsistent with expected blood loss for the procedure with ANY ONE 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 with ANY ONE of the following:

Admit for observation and evaluation

Replenish fluids if necessary

ANY ONE of the following for a patient with Postoperative effects require inpatient management, including, but not limited to the following:

Excessive pain, uncontrolled by oral analgesics if ALL of the following are met:

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 are met:

IV fluids and electrolytes

Parenteral or rectal treatment until patient has adequate oral intake

Subsequent control with oral medication

[Goal Length Of Stay: 23-hour observation]* (BCBST modification effective September 18, 2009*)

[Note: Goal length of stay assumes optimal recovery, decision-making, and care. Patients may be discharged to a lower level of care (either later than or sooner than the goal) when it is appropriate for their clinical status and care needs.]* (BCBST modification effective September 18, 2009*)

SOURCES

BlueCross BlueShield of Tennessee network physicians. June - September 2009. (BCBST modification effective September 18, 2009*)

	Added:


	A 23-hour observation may be appropriate for ANY ONE of the following: ALL of the following for a patient with Unstable vital signs (blood pressure and pulse not within 20% of preoperative baseline): IV fluids as appropriate Evaluation for possible surgical complications Close monitoring of vital signs until ASDC met ALL of the following for a Patient who is not alert, or has a mental status either abnormal or not at baseline: Admission for more postanesthesia recovery time Possible arterial blood gas (ABG) Evaluation for possible surgical complications ANY ONE of the following for a patient with an Abnormal temperature (patient either febrile or hypothermic with temperature inappropriate for outpatient treatment of condition): Evaluation for possible infection if febrile Warm patient up from postanesthesia hypothermia ANY ONE of the following for a patient Unable to ambulate or to achieve appropriate activity level postprocedure: Admission for more postanesthesia recovery time Evaluation for possible surgical complications Assistance with ambulation until ability returns (as appropriate) ANY ONE of the following for a patient with an Unsatisfactory operative site: Excessive postoperative bleeding, inconsistent with expected blood loss for the procedure with ANY ONE 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 with ANY ONE of the following: Admit for observation and evaluation Replenish fluids if necessary ANY ONE of the following for a patient with Postoperative effects require inpatient management, including, but not limited to the following: Excessive pain, uncontrolled by oral analgesics if ALL of the following are met: 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 are met: IV fluids and electrolytes Parenteral or rectal treatment until patient has adequate oral intake Subsequent control with oral medication [Goal Length Of Stay: *23-hour observation] (BCBST modification effective September 18, 2009)* [Note: Goal length of stay assumes optimal recovery, decision-making, and care. Patients may be discharged to a lower level of care (either later than or sooner than the goal) when it is appropriate for their clinical status and care needs.]* (BCBST modification effective September 18, 2009) SOURCES* BlueCross BlueShield of Tennessee network physicians. June - September 2009. (BCBST modification effective September 18, 2009*)