Part I: Service or Severity of Illness Criteria
Read the definitions below for Intensity of Service and Severity of Illness, noting the differences between the two. Review the list of criteria in #1 through #10 which includes both Intensity of Service and Severity of Illness criteria, based on the definitions; identify which type each one is. Then, within this table, list the policy criteria in the appropriate column based upon whether they are Intensity of Service or Severity of Illness criteria.
IS Criteria: Intensity of Service
Measures the level of intensity of treatment needed or resources used – “How much care do they need?”
SI Criteria: Severity of Illness
A measure of how serious is the patient’s illness or condition – “How sick are they?”
Policy:
The following criteria indicate medical necessity and continued hospital stay:
Part II: Utilization Review for 3 Patients
Perform a Utilization Review on 3 patients. Below are notes from 3 patients who are currently inpatients at the hospital. Based on the notes provided, complete the Utilization Review Form that follows. Be sure to indicate if the documentation in the notes supports continued stay or if you believe the patient should be discharged.
Patient 1:
8/16/xx
0200 Sleeping in bed, breathing easily.
0115 SVN with albuterol 0.5 cc given.
0130 Breathing easy, good air exchange. Lungs fields with only minor crackles. No c/o at
this time.
0640 Feels better after treatment. Improving air flow in all lung fields. Foley catheter removed.
IV discontinued.
0700 Up to BR, voids well.
0800 Dr. Wainwright visits. Patient resting well. Blood sugar 130, vital signs stable. Ext. no edema. VS stable. Patient alert & oriented.
Patient 2:
3/29/xx
Afebrile, VSS
Drainage minimal
Continue present treatment.
IV Percocet every 4 hours
3-30-xx
Afebrile
VSS
Vitals stable
Drainage minimal
Drains removed
IV Percocet every 6 hours
Patient 3:
1-23-xx
7-3pm Tylenol #3 given for incisional pain.
Has been ambulating well in hallway without assistance.
Up to bathroom ad lib.
Dressing dry.
Staples removed, Steri-Strips applied.
Taking diet well.
Continues to complain of abdominal pain, possible gas.
Showered.
Temp 101.9 degrees.
Patient feeling dizzy on ambulation.
Utilization Review Form
Complete this Utilization Review Form, indicating if continued stay or discharge is appropriate based on the documentation in the notes.
Be sure to state, on the review form, the specific Intensity of Service or Severity of Illness criteria from the previous list, if you feel the patient should continue their stay. If a patient does not meet any of those criteria than a decision for discharge should be made.
Part III
For Part 3 of this assignment, consider the patient who has diabetes and has begun the process of monitoring, medications, lab work and dietary counseling involved with that condition. Perform an online search using your favorite search engine by using terms such as, “diabetes case management.”
Write 2-3 paragraphs below summarizing specific, potential benefits for diabetic patients who have been provided with case management services. Include a description of services the case management could include, and specific health benefits that research has demonstrated can result from diabetes case management. Be sure to cite all your sources appropriately using APA format.
They have a magnificent team. These people are always kind and willing to listen to your concerns or issues. Better yet, your assignment is always ready before the time, they usually send you a draft to double-check before they finalize your paper.
Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.
You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.
Read moreEach paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.
Read moreThanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.
Read moreYour email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.
Read moreBy sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.
Read more