Implementing discharge criteria in day surgery

Documentation needed two of three below must be met or exceeded: Coding of the visits during a six-day hospitalization of an eighty year old patient with a presumptive diagnosis of pneumococcal pneumonia and low oxygen saturation. First day after the day of admission:

Implementing discharge criteria in day surgery

Introduction Increasingly, physicians and medical institutions are being asked to demonstrate care quality by documenting performance measurement against national benchmarks,[1—3] necessitating changes in the structure of systems and methods of evaluating them for outcomes.

A cardiac care goal, for example, is to administer or prescribe aspirin at discharge for a patient with myocardial infarction or to advise smoking cessation.

Do I need a special diet before surgery? Your surgeon may request that you take a special diet before surgery. This is usually Optifast which is a taken as three shakes plus vegetables as per dietitian instruction. Nursing homes require that an RN be present to assess residents and to monitor their outcomes. The RN's job duties include implementing care plans, administering medications, recording and maintaining accurate reports for each resident, monitoring and recording medical changes and providing direction to the nursing assistant and .  · Discharge criteria were revised based on current evidence identified in the literature. The revised P&P navigated the organizational approval process and was

Payment percentages to physicians or hospitals may be reduced or withheld until the goal is met. Care providers also must decide which populations are at risk, synthesize efficacy results from clinical trials with obstacles to overcome in the real world setting, and target the most remunerative or critical disease or procedure to monitor.

Also, setting up or modifying care processes in a busy clinical setting, instituting information technology support systems, and training staff is a costly venture.

Who pays for these efforts?

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Do they always pay off? Performance standards vary by clinical setting, case-mix of populations treated, type of hospital, those on Medicaid versus private pay, sampling strategies, and databases examined.

Physician records for recredentialing are neither uniformly maintained nor are they available for public scrutiny. How is the quality judged in this case? Who has the fiduciary responsibility for her care? How do we tie payment for the extra supervised care to the appropriate assessment of her cognitive limitations, which ultimately delays discharge?

How can we measure failures in the quality of transitions between systems? How can we accurately collect these data? Given that suicide is a grave but low occurrence event, a very large sample would be required to test outcomes, making the task onerous. Patients also are not randomly assigned to physicians or services, particularly in psychiatry.

Procedures, such as electroshock therapy ECTlend themselves to measurement better than therapy. One could set up benchmarks for noncognitive complications for ECT, establish numbers for excellence in care, and study the procedure for the interventions that make a difference. For example, does the use of adequate antihypertensives defined by readings prior to treatment prevent strokes?

The thresholds, of course, will have to be agreed upon. Falls causing significant injury in the elderly, elopements of dangerously ill patients who have been certified, rates of restraint and seclusion use for severely ill patients classified by case mix and illness severity, and medication errors among commonly used psychotropic medications all lend themselves to evaluation, benchmarking, and systems interventions.

How do we determine excellence? It may be possible to identify common errors among psychotropic medications if several institutions caring for different diagnostic and ethnic groups, both outpatients and inpatients, collaboratively reviewed their databases, made interventions, and tracked the problem.

Outliers at both ends can be identified, and the best systems examined for processes that decrease error. This includes examinations of technology support systems for order entry. Staff can be trained to incorporate checks or failsafe mechanisms. The project must be ongoing to continue maintaining quality.

It is only a matter of time before revenue streams from third-party payers is examined for the practice of psychiatry and linked to performance expectations by benchmarks, guidelines, and norms.

These programs address performance dimensions of credentialing, risk management, documentation, reduction in adverse events, improvement of care processes, and finally, education of physicians and funding research. Setting annual goals that apply to clinical service and quality as well as to hospital utilization management and performance goals is integral to this development.

Published research serves as a benchmark in this area. Some areas for consideration of psychiatric practice improvement but not an exhaustive list are as follows: Beginning with the assessment of competency of all staff to render psychiatric care well, setting up an interdisciplinary framework of leadership to choose goals and a structure to gather data are crucial.

Implementing discharge criteria in day surgery

· Originally published September / Revised June PE. Day surgery has become routine in the treatment of many clinical conditions. It may reduce patients' risk of acquiring hospital-related infections and having complications after the surgery, but it can create other challenges in the post-operative by Geetha Jayaram, MD, MBA.

AUTHOR AFFILIATION: Dr. Jayaram is the Associate Professor of Psychiatry, Johns Hopkins University, Department of Psychiatry, Baltimore, Maryland. Introduction.

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Increasingly, physicians and medical institutions are being asked to demonstrate care quality by documenting performance measurement against . Inpatient hospital visits: Initial and subsequent subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of the 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity.

Day surgery patients have a finite time on the day surgery unit before discharge that same day. Therefore, prompt management of pain and nausea and vomiting and early mobilization are paramount. A more rapid recovery from anaesthesia results in quicker Overview.

According to a study by RAND Health, the U.S. healthcare system could save more than $81 billion annually, reduce adverse healthcare events, and improve the quality of care if health information technology (HIT) is widely adopted.

The most immediate barrier to widespread adoption of technology is cost despite the patient benefit from . The Public Inspection page on offers a preview of documents scheduled to appear in the next day's Federal Register issue.

The Public Inspection page may also include documents scheduled for later issues, at .

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