(Solved by Humans)-Instructions Download and complete the Unit 4 Utilization Review

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Instructions

Download and complete the Unit 4 Utilization Review Case Management Activity?. First, you will be distinguishing between Severity of Illness and Intensity of Service for a list of indicators. You will then perform a utilization review and make decisions about discharge planning for 3 patients.Share how this activity assesses legal and ethical considerations related to HIM and governance of the facility.

HI230: Quality Assurance and Statistics in Health Information

Unit 4 Assignment: Utilization Review
Case Management Activity
Part I: Criteria Review the two types of criteria used at this hospital:
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
? Measures how serious the patient?s illness or condition is: ?How sick are they??

Policy: The following criteria indicate medical necessity and continued hospital stay
IV pain medications 3 or more times daily
White blood count >15,000/cu.mm.
Special neurological monitoring every 2 hours or more
Oral temperature > or equal to 101 degrees
Uncontrolled active bleeding at present time
Sudden onset of unconsciousness
Blood culture positive for pathogens
Respiratory assistance required
Surgery performed
Acute onset of chest pain/pressure

Instructions: In a table, indicate which of the above criteria are Intensity of Service criteria and which
are Severity of Illness criteria.
IS Intensity of Service

SI Severity of Illness

HI230: Quality Assurance and Statistics in Health Information

Part II: Perform Utilization Review on 3 patients. Below are notes from 3 patients who are currently
inpatients at the hospital. Based on these notes and the information from the table you created in Part
I, complete the utilization review form below indicating if the documentation supports continued stay,
or if you believe the patient should be discharged. If discharge is indicated, a Discharge Form should
be sent to the attending physician.
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

HI230: Quality Assurance and Statistics in Health Information

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 Worksheet
Sample
Criteria
Indicator

Onset of Chest
Pain

Decision

Continued Stay

(Continued
Stay or
Discharge
Action

None

Patient 1

Patient 2

Patient 3



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