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Appendix 6: Modified Standard Assessment Evaluation Protocol
For further details see the full version of the Appropriateness Evaluation Protocol Criteria as adapted for the Manchester Utilisation Review Project (2002/03). 64*
I Admission Criteria
IA Intensity of service
IA1 Surgery or other procedure in 24 hours, requiring:
(a) general/regional anaesthesia; and/or
(b) equipment or other facilities available only for in-patients
IA2 Vital signs monitoring at least every two hours
IA3 Intravenous medication and/or fluid replacement (does not include tube feeds)
IA4 Observation for toxic reaction to medication
IA5 Continuous or intermittent (at least every 8 hours) respiratory assistance
IB Severity of illness
IB1 Severe electrolyte/acid base abnormality - any one of the following 4 sets:
(i) Na < 123mEq/L or > 156mEq/L
(ii) K < 2.5mEq/L or > 6.0mEq/L
(iii) C02 combining power < 20mEq/L or > 36mEq/L
(iv) arterial pH < 7.3 or > 7.45
IB2 Acute loss of sight or hearing (within 48 hours of admission)
IB3 Acute loss of ability to move any body part (within 48 hours of admission)
IB4 Persistent fever >= 38ºC for more than 5 days
IB5 Active bleeding
IB6 Wound dehiscence or evisceration
IB7 Pulse rate < 50 per minute or > 140 per minute
IB8 Blood pressure: systolic < 90mmHg or > 120mmHg and/or Diastolic < 60mmHg or > 120mmHg
IB9 Sudden onset of unconsciousness (coma or unresponsiveness)
IB10 ECG evidence of acute ischaemia, must be suspicion of new MI
IB11 Suspicion of MI, admitted for Troponin T analysis 12 hours post pain onset.
II Adult Day of Care Criteria
IIA Medical services
IIA1 Procedure in operating room (theatre) that day (ie the day reviewed)
IIA2 Scheduled for procedure in operating room the next day requiring extraordinary pre-operative consultation or evaluation
IIA3 Cardiac catheterisation that day
IIA4 Angiography that day
IIA5 Biopsy of internal organ that day
IIA6 Invasive CNS diagnostic procedure that day
IIA7 Any test requiring strict dietary control
IIA8 Treatment requiring frequent dose adjustments under direct medical supervision
IIA9 Close medical monitoring by a doctor at least three times per day
IIA10 Post operative day (after operating room or procedures 3-6 above)
IIB Nursing/life support services
IIB1 Continuous or intermittent (at least every 8 hours) respiratory assistance
IIB2 Parenteral therapy: intermittent or continuous IV fluid with any supplementation
IIB3 Continuous monitoring of vital signs, at least every 30 minutes, for at least 4 hours
IIB4 Fluid balance
IIB5 Major surgical wound and drainage care
IIB6 Close nurse monitoring under physician's orders at least three times per day
IIC Patient condition
IIC1 Inability to void or absence of intestinal movements in last 24 hours
IIC2 Transfusion due to blood loss in last 48 hours
IIC3 Ventricular fibrillation or ECG evidence of acute ischaemia in last 48 hours
IIC4 Fever > 39ºC rectally (or at least 38ºC orally) in last 48 hours if the patient was admitted for reason other than fever (or > 100ºF (R) or 101ºF (OR))
IIC5 Coma: unresponsive for at least one hour in last 48 hours
IIC6 Acute confusional state in last 48 hours, not due to alcohol withdrawal
IIC7 Signs or symptoms due to acute haematologic disorders (significant neutropenia, anaemia, thrombocytopenia, leucocytosis, or thrombocytosis yielding signs or symptoms) in last 48 hours
IIC8 Progressive acute neurological difficulties in last 48 hours
An example of how the assessment evaluation protocol might be modified for use as a checklist:
ACUTE HOSPITAL ADMISSION CRITERIA One or more criteria met - agreement for the admission day |
|---|
| | Please tick if
criteria present |
| (CLINICAL SERVICES) | |
1. | Procedure in theatre within 18 hours. | |
2. | Monitoring of cardiac rhythm, blood pressure, pulse, temperature or respiration every 2 hours for at least 2 observations. | |
3. | Any form of artificial ventilation or respiratory support (new or changing). | |
| (PATIENT CONDITION) | |
4. | Severe electrolyte/acid-base abnormality. | |
5. | Acute loss of ability to move a limb or acute loss of mobility within 48 hours prior to admission. (Exclude global weakness.) | |
6. | Acute impairment or reduction of sight, hearing or swallowing within 48 hours prior to admission. | |
7. | Recent acute internal bleeding (except haematuria unless requiring catheterisation). | |
8. | Acute rupture of recent surgical wound. | |
9. | Pulse rate < 50 or > 140 per min. | |
10. | Systolic blood pressure < 90mmHg or > 200mmHg, diastolic < 60mmHg or > 120mmHg. | |
11. | Acute confusional state/coma/unresponsiveness. | |
12. | ECG evidence of acute ischaemia (including unstable angina with suspicion of acute MI). | |
13. | Overdoses/ingestion waiting for psychiatric opinion. | |
14. | Severe pain requiring urgent diagnostic assessment or parenteral analgesia. | |
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