Admission Disposition: Inpatient or Outpatient Observationampeterson03
This was a staff presentation for Rio Grande Hospital staff in 2012 regarding the correct admission status for patients, billing, and the impact that RACs auditors have on the hospital
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Admission Disposition: Inpatient or Outpatient Observationampeterson03
This was a staff presentation for Rio Grande Hospital staff in 2012 regarding the correct admission status for patients, billing, and the impact that RACs auditors have on the hospital
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Why invest into infodemic management in health emergenciesTina Purnat
A lecture discussing the challenge of health misinformation and information ecosystem in public health, how this impacts demand promotion in health, and how this then relates to responding to misinformation and infodemics in health emergencies. Appended with lots of tools, guidance and resources for people who want to do more reading.
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Ed...kevinkariuki227
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Edition by Donnelly-Moreno, Verified Chapters 1 - 72, Complete Newest Version.pdf
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Edition by Donnelly-Moreno, Verified Chapters 1 - 72, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
Why invest into infodemic management in health emergenciesTina Purnat
A lecture discussing the challenge of health misinformation and information ecosystem in public health, how this impacts demand promotion in health, and how this then relates to responding to misinformation and infodemics in health emergencies. Appended with lots of tools, guidance and resources for people who want to do more reading.
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Ed...kevinkariuki227
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Edition by Donnelly-Moreno, Verified Chapters 1 - 72, Complete Newest Version.pdf
TEST BANK For Timby's Introductory Medical-Surgical Nursing, 13th American Edition by Donnelly-Moreno, Verified Chapters 1 - 72, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
This article is all about what AI trends will emerge in the field of creative operations in 2024. All the marketers and brand builders should be aware of these trends for their further use and save themselves some time!
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...Applitools
During this webinar, Anand Bagmar demonstrates how AI tools such as ChatGPT can be applied to various stages of the software development life cycle (SDLC) using an eCommerce application case study. Find the on-demand recording and more info at https://applitools.info/b59
Key takeaways:
• Learn how to use ChatGPT to add AI power to your testing and test automation
• Understand the limitations of the technology and where human expertise is crucial
• Gain insight into different AI-based tools
• Adopt AI-based tools to stay relevant and optimize work for developers and testers
* ChatGPT and OpenAI belong to OpenAI, L.L.C.
1. Title of Presentation Arial Regular 22pt
Single line spacing
Up to 3 lines long
Date 20pts
Author Name 20pts
Author Title 20pts
Guidelines to the Guidelines
2. Objectives:
• Participant will understand the purpose of medical
guidelines
• Participant will understand importance of evidence
based medicine in relation to medical guidelines
• Participant will be able to use Interqual guidelines as
designed
• Participant will be able to utilize Interqual guidelines in
their every day practice of case management
3. Guidelines to the Guidelines
Clinical Guidelines
• Clinical guidelines are defined as: Medical
interventions based on medical practice
that has been proven to be best practice.
It is commonly termed “evidence based
medicine”.
4. Guidelines to the Guidelines
Guidelines
• There are two distinct companies that produce
medical/acute guidelines
– Milliman
–Focus is on how the patient presents. They focus on
symptom rather than treatment
For example, if a patient comes in with pneumonia, they
will focus on the patients respiratory status versus
what treatment is being given.
5. Guidelines to the Guidelines
Interqual
- Interqual guidelines
Interqual’s focus is on the intensity of which the
patient is being treated.
If we take the same patient with pneumonia, they will
focus on what treatment is being done, such as
antibiotics, respiratory treatments etc.
6. Guidelines to the Guidelines
Interqual
• Interqual breaks down the information in two ways
– 1. Level of care guidelines. These guidelines are to make sure
that the patient is in the correct level of care.
– 2. Body systems. The guidelines are then broken down by
systems such as GI and ID
7. Guidelines to the Guidelines
Further Breakdown
Interqual breaks it down further into two additional
subsets
Severity of Illness or SI
This is used on admission/preadmission only. Patient
must meet severity of illness before you can review for
intensity of service. This is done upon admission.
Intensity of service
These are basically physician orders. What is being
done for the patient. It must be met initially and with
continued stay
8. Guidelines to the Guidelines
Severity Of Illness
• This criteria consist of objective, clinicals indicators of
illness which focus on the patient’s clinical presentation
and/or diagnosis
• Time requirements vary based on the level of care
• Grouped by reason for admission and alphabetized
9. Guidelines to the Guidelines
Continued
• Most Severity of Illness or SI are organized into
subsets
– Clinical Findings
– Imaging Findings
– ECG findings
– Laboratory findings
10. Guidelines to the Guidelines
Intensity of Service
• This criteria consists of monitoring and therapeutic
services, either by themselves or together, that can
only be administered at a specific level of care.
• Intensity of service criteria is broken down again into
two sections
– One IS This means you only need to meet one of these clinical
to meet criteria
– Three IS This mean the patient has to have at least three of
these interventions to meet criteria
IS EXCLUDES PO MEDICATION UNLESS INDICATED
11. Guidelines to the Guidelines
Interqual basics
• Interqual contains the five basic review types
–Preadmission review. This is for planned
admission for a procedure
–Admission review. This is done upon the
patient’s admission to the hospital. It includes
Observation and Inpatient admissions
12. Guidelines to the Guidelines
Types of review continued
–Discharge review. This is to determine the
safety of discharge or transfer from one level of
care to another
–Continued Stay review. This is performed to
determine if the level of care is still appropriate.
Only intensity of service criteria is used.
–Secondary review. This review occurs when
the primary reviewer does not find that patient
meets criteria. It is up to the individual
originations to determine who does those
reviews
13. Guidelines to the Guidelines
Admission Review Process
• This is done when the patient is admitted to a level of
care to determine if that level of care is appropriate. If
the patient is transferred from a lower level of care to a
higher level of care, an admission review is also
required. Both the Severity of Illness (SI) and the
Intensity of service (IS) rules from the same criteria
subset must be met.
14. Guidelines to the Guidelines
Steps
• Identify the level of care based on the patients current
level
• Select the most appropriate criteria subset based on
the patient’s predominant clinical findings
• Review specific clinical information derived at the time
of admission. ER data can be utilized.
• Apply the SI rule – pt must meet severity of illness
criteria
• Apply the IS rule – pt must meet intensity of service
criteria
15. Guidelines to the Guidelines
Admission review findings
• When the SI and IS rules are met.
1. Approve stay and schedule a continued stay review
• SI and IS rules not met.
1. Obtain additional information from admitting MD or
other caregivers
2. If additional information does not meet SI or IS,
discuss alternate levels of care with attending md.
3. Facilitate transfer if the attending physician is
agreeable
16. Guidelines to the Guidelines
Continued Stay Review
Continued stay review is performed to determine the
appropriateness of continued stay at a level of care.
Apply the intensity of service criteria (one IS/*three IS)
The patient has to meet criteria on a daily basis
17. Guidelines to the Guidelines
Steps
• Begin at the same criteria subset used during the
Admission review unless
– Pt has been transferred to a lower level of care
– Pt has been transferred to a higher level of care – then it would
be an admission review
– Pt remains at the same level of care but their medical condition
has changed. You do not need to meet severity of illness.
18. Guidelines to the Guidelines
Steps continued
• Review patient specific clinical information
• Apply IS by selecting the IS criteria based on
treatments, medication or interventions making sure
they meet all the rules for duration, time frames and
number of criteria
19. Guidelines to the Guidelines
Continued stay review actions
• If IS is met, approve level of care for that day and
schedule a continued stay review
• Three *IS met, approve level of care for that day.
Review the discharge screens and document the
discharge plan. Schedule a continued stay review.
• IS or three*IS not met or IS and discharge review
criteria are selected, obtain additional information from
the attending MD or other caregivers. If IS is not met,
perform discharge review.
20. Guidelines to the Guidelines
Discharge Review
• Discharge reviews are done when criteria for continued
stay are not met, an IS criteria is selected that states
“and discharge review”, or to assist in determining the
next appropriate level of care within the facility or
transfer to another facility.
21. Guidelines to the Guidelines
Steps
• Select the same criteria subset used for the admission
or continued stay review and apply the DS rule the
appropriate level of care
– One IS that states “and discharge review”
22. Guidelines to the Guidelines
Discharge Review Actions
• If the discharge screen is NOT met, approve the day
and schedule the next review within 24 hours.
• On the next review, if DS is still not met, it should go to
secondary review.
23. Guidelines to the Guidelines
Discharge review actions continued
• If the discharge screen is met and discharge is
scheduled, no action required
• If discharge not scheduled, contact the attending
physician to discuss the d/c plan and ALOC options
• Facilitate discharge or transfer if the attending
physician agrees
24. Guidelines to the Guidelines
Secondary Review
• This review is completed by a supervisor, specialist or
a physician may conduct a secondary review.
• Organizational policy should determine the
qualifications of the reviewer as well as the extent to
which the reviewer has oversight
• The secondary reviewer determines the medical
necessity of admission or continued stay based on
review of the medical record, discussions with nursing,
discharge planner and attending physician and by
applying clinicals experience.
25. Guidelines to the Guidelines
Interqual Tips
• Don’t be afraid to use the reference materials
– The index can assist in identifying the appropriate criteria
subset
– Inpatient list identifies procedures that are appropriate for the
inpatient setting
– Abbreviation and symbols list
– Drug list
26. Guidelines to the Guidelines
Process Tips
• Review all notes attached to criteria. They are in
parentheses and are numbered.
• PRN medication can be used to meet the IS criteria
during an admission review but only if the required
frequency is met
• Oxygen saturation is based on room air measurements
unless otherwise noted.
• Treatments or services that are only given once while
in the ED cannot be used for IS criteria
27. Guidelines to the Guidelines
Process Tips continued
• If there is no IS on an admission review, this does not
meet criteria. You can use the discharge screen to
determine an alternate level of care
• A 24 hour grace period can be given, one time only,
when DS are not met and the IS rule (one IS/*three IS)
is not met. For example:
– A therapeutic pause of medication is needed.
28. Guidelines to the Guidelines
Tips
• It is acceptable for a patient to be in observation even
if they meet acute criteria. This can occur when the
expected length of stay is less than 24 hours
• Don’t confuse patient status issues with billing issues.
Some payers contract with facilities to provide
observation level of care when it could be either
inpatient or outpatient