UM Guidelines

This Supplemental Utilization Management Guideline will be Archived in favor of MCG's existing Observation Care Guidelines.

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	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 baselineas indicated by 1 or more of the following: IV fluids as appropriate Evaluation for possible surgical complications Close monitoring of vital signs until stability achieved Pulmonary artery catheterization ECG to evaluate for cardiac arrhythmias or myocardial infarction Patient who is not alert, or has a mental status either abnormal or not at baseline as indicated by 1 or more of the following: ABG and evaluation of oxygenation Laboratory evaluation (eg, CBC with differential, metabolic panel) to evaluate and treat metabolic derangements, fluid status Neurologic checks to evaluate for stroke Evaluation for possible surgical complications Abnormal temperature: patient either febrile or hypothermic with temperature inappropriate for outpatient treatment of condition as indicated by 1 or more of the following: Evaluation for malignant hyperthermia if febrile Evaluation for possible infection if febrile Warming patient up from postanesthesia hypothermia Inability to ambulate or to achieve appropriate activity level postprocedure as indicated by 1 or more of the following: Evaluation for possible surgical complications Assistance with ambulation until ability returns (as appropriate) Operative site is unsatisfactory with 1 or more of the following: Excessive postoperative bleeding, inconsistent with expected blood loss for the procedure as indicated by 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) Nerve injury Postoperative effects with 1 or more of the following: Excessive pain, uncontrolled by oral analgesics as indicated by 1 or more of the following: Parenteral treatment until level of pain is acceptable to the patient Subsequent management with oral analgesics Regional analgesia interventions (eg, nerve block) Excessive nausea and vomiting uncontrolled by oral medication as indicated by 1 or more of the following: IV fluids and electrolytes Parenteral or rectal treatment until patient has adequate oral intake Subsequent control with oral medication Calcium or parathyroid hormone fluctuation with 1 or more of the following: Calcium supplementation Vitamin D supplementation Observation Care Discharge Criteria Discharge to non-acute-care follow-up is appropriate for a patient with ALL of the following: Physiologic recovery Stable vital signs Patient alert Temperature appropriate Activity level appropriate Operative site appropriate Postoperative effects resolved or managed Voiding status acceptable Competent person available to accompany patient (if required) No complicating features References BlueCross BlueShield of Tennessee network physicians. July - September 2024. 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. 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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