UM Guidelines
Ambulatory Surgery Complications

Inpatient and Surgical Care (ISC)

BCBST modification effective September 10, 2013*


Added:
   

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
Goal Length Of Stay: Observation

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.

References

BlueCross BlueShield of Tennessee network physicians. August - September 2013.

 

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