Ambulatory Surgery Complications


	UM Guidelines

Inpatient and Surgical Care (ISC)

BCBST modification effective October 12, 2007*

Deleted from: Clinical Indications

Milliman Care Guidelines Clinical Indications were deleted.

Added:

23-hour observation is indicated for any 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 ASDC met

Patient not alert, or with mental status either abnormal or not at baseline with all of the following:

Admission for more postanesthesia recovery time

Possible arterial blood gas

Evaluation for possible surgical complications

Temperature abnormal (patient either febrile or hypothermic with temperature inappropriate for outpatient treatment of condition) with any of the following:

Evaluation for possible infection if febrile

Warm up patient from postanesthesia hypothermia

Inability to ambulate or to achieve appropriate activity level postprocedure with any of the following:

Admission for more postanesthesia recovery time

Evaluation for possible surgical complications

Assistance with ambulation until ability returns (as appropriate)

Operative site unsatisfactory with any of the following:

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

Transfusion if necessary

Control of bleeding locally and evaluation for reoperation

Observation until bleeding is consistent with expected blood loss for the procedure

Excessive postoperative drainage, inconsistent with expected drainage for the procedure with any of the following:

Admit for observation and evaluation

Replenish fluids if necessary

Postoperative effects require inpatient management, including, but not limited to the following:

Excessive pain, uncontrolled by oral analgesics with 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 with 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: 23-hour observation]* (BCBST modification effective October 12, 2007*)

[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 October 12, 2007*)

* These guideline(s) have been revised from the Milliman USA Milliman Care Guidelines. The portions of the guideline(s) which have been revised are identified through the use of [insert: italic, boldface, underlined, etc. as appropriate] text, and Milliman USA has neither reviewed nor approved the modified material. Any statement to the contrary or association of the modified material with Milliman USA is strictly prohibited. This document has been classified as public information.

The above information only contains the modified portion of the Milliman Care Guideline. If you wish to view the complete Milliman Care Guideline, please contact Milliman USA.

	Deleted from: Clinical Indications


	Milliman Care Guidelines Clinical Indications were deleted.

	Added:


	23-hour observation is indicated for any 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 ASDC met Patient not alert, or with mental status either abnormal or not at baseline with all of the following: Admission for more postanesthesia recovery time Possible arterial blood gas Evaluation for possible surgical complications Temperature abnormal (patient either febrile or hypothermic with temperature inappropriate for outpatient treatment of condition) with any of the following: Evaluation for possible infection if febrile Warm up patient from postanesthesia hypothermia Inability to ambulate or to achieve appropriate activity level postprocedure with any of the following: Admission for more postanesthesia recovery time Evaluation for possible surgical complications Assistance with ambulation until ability returns (as appropriate) Operative site unsatisfactory with any of the following: Excessive postoperative bleeding, inconsistent with expected blood loss for the procedure with any of the following: Transfusion if necessary Control of bleeding locally and evaluation for reoperation Observation until bleeding is consistent with expected blood loss for the procedure Excessive postoperative drainage, inconsistent with expected drainage for the procedure with any of the following: Admit for observation and evaluation Replenish fluids if necessary Postoperative effects require inpatient management, including, but not limited to the following: Excessive pain, uncontrolled by oral analgesics with 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 with 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: 23-hour observation]* (BCBST modification effective October 12, 2007) [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 October 12, 2007*)