InterQual Acute Criteria: Demonstration of Condition Specific Subsets
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1 InterQual Acute Criteria: Demonstration of Condition Specific Subsets February 24, 2011
2 Today s Presenters Lollie Dubiel, RN, BSN Sr. Product Manager McKesson Laura McIntire, RN, BSN, MA Clinical Lead McKesson
3 Objectives Learn how to conduct a review using condition specific subsets Book View Software Pediatric Adult Understand how to use new concepts Know where and when to learn more 3
4 Key Resource: MHS Customer Hub Self-registration is Easy! 1. Go to the MHS Customer Hub login page 2. Click Need a User ID and Password? 3. Enter your address 4
5 Agenda Introducing Condition Specific Subsets Demonstration Case Study 1: Pediatric Criteria / Book View Q&A Case Study 2: Adult Criteria / Software View Support for Transition Q&A 5
6 Agenda Introducing Condition Specific Subsets Demonstration Case Study 1: Pediatric Criteria / Book View Q&A Case Study 2: Adult Criteria / Software View Support for Transition Q&A 6
7 Evolving Acute to Meet Your Needs: Introducing Condition Specific Subsets InterQual Condition Specific Criteria subsets are evidence-based, acute care criteria organized by primary conditions, enabling A more proactive, intuitive review process With the integration of relevant complications, comorbidities and guideline standard treatments Decreases in inappropriate admissions, avoidable days and readmissions By focusing on appropriateness and quality, and integrating utilization and case management Lower administrative costs Due to increased efficiencies and straightforward payer-provider communication 7
8 InterQual But Better InterQual 2011 has the same Industry leading evidence-based criteria Clinical rigor, depth and specificity Objective, rules-based, nested decision trees Severity-driven admissions criteria plus Reformatted for more efficient, intuitive, streamlined review process Organized by primary conditions to include complications and comorbidities Proactive plan of care with increased focus on discharge readiness 8
9 Acute Content Roadmap Adult Asthma Stroke / TIA Heart failure ACS Pneumonia Epilepsy 2011 Pediatric Asthma Pneumonia Epilepsy Croup ~ 25 additional conditions Content complete 9
10 Key Condition Specific Process Changes No concept of Discharge review type No slashes, minimal abbreviations All content related to a condition removed from traditional subsets No need for admission review when moving to a higher LOC Responder only present if D/C is expected or clinically reasonable Continued stay is based on Episode Day SI time requirement = symptom or finding within 24h Condition Specific notes highlight standards of care Prompts in the workflow Redirection New concepts (criteria not met) 2/24/
11 Condition Specific Reviews When in a condition specific subset, if you need to move up to a higher LOC, within that subset, then follow Episode days to a traditional subset and up to a higher LOC: Do an ADMIT review in a traditional subset and follow traditional review process to a new condition specific subset: Start with Episode day 1 When in a condition specific subset, and a comorbidity comes up that is covered in that subset, stay in that subset until the patient exhausts the episode days and a comorbidity comes up that indicates you should use a different subset, move to the recommended subset 11
12 Agenda Introducing Condition Specific Subsets Demonstration Case Study 1: Pediatrics Criteria / Book View Q&A Case Study 2: Adult Criteria / Software View Support for Transition Q&A 12
13 Demonstration 13
14 Agenda Introducing Condition Specific Subsets Demonstration Case Study 1: Pediatrics Criteria / Book View Q&A Case Study 2: Adult Criteria / Software View Support for Transition Q&A 14
15 Case Study 1: Pediatrics / Book View Jacob, an 18-month-old boy, is brought into the ED by his parents who state that he has developed a barking cough. In the ED, he is noted to have inspiratory stridor and labored breathing with grunting. He received dexamethasone 6.6 mg IM and racemic epinephrine 0.55 mg via nebulizer. His stridor did not improve. Clinical examination: Lung sounds with inspiratory stridor on auscultation Temp: 99.1 F PO HR: 120 BP: 90/50 O2 sat: 92% on RA Weight 11 kg
16 Case Study 1 Medical Practitioner Admission Orders: Admitting diagnosis: Croup Racemic epinepherine nebulizer q2h 2L O 2 via nasal cannula Oximetry Strict I/O monitoring Diet as tolerated
17 Case Study 1 Admission Review (Episode Day 1) 7/21/
18 Case Study 1 Continued Stay Review (Episode Day 2) Overnight Jacob was started on D51/2NS 25cc/hr because he wasn t taking any PO s. His breathing has improved, was weaned off oxygen, and is still receiving racemic epinepherine nebs rate changed to q6h.
19 Case Study 1 Continued Stay Review (Episode Day 2) 7/21/
20 Case Study 1 Continued Stay Review (Episode Day 3) Yesterday afternoon Jacob s PO intake improved and today IVF s were weaned to KVO. Vital signs are stable. Medical Practitioner Orders: D/C IVF Discharge to home Schedule follow-up with PCP for this week
21 Case Study 1 Continued Stay Review (Episode Day 3) 7/21/
22 Agenda Introducing Condition Specific Subsets Demonstration Case Study 1: Pediatrics Criteria / Book View Q&A Case Study 2: Adult Criteria / Software View Support for Transition Q&A 22
23 Agenda Introducing Condition Specific Subsets Demonstration Case Study 1: Pediatrics Criteria / Book View Q&A Case Study 2: Adult Criteria / Software View Support for Transition Q&A 23
24 Case Study 2 Adult Criteria / Software View Mary, a 74-year-old female, presented to the ED with complaints of worsening dyspnea over the last week and trouble walking even short distances. She has a history of heart failure and no history of renal disease. She had been tolerating her medication regimen at home. Clinical Findings/Physical Exam: Alert and oriented x3 2+ bilateral pedal edema Lung sounds with bilateral rales Chest x-ray reveals bilateral pleural effusions B/P 142/84 mmhg, P 109, R 32, T 98.2ºF po Oxygen saturation 90% on room air BUN 35.0, Creatinine 1.3, electrolytes WNL
25 Case Study 2 Medical Practitioner Admission Orders: Admit Vital signs q 4h, include oximetry Continuous cardiac monitoring Furosemide 80mg IV stat and q12h Oxygen to maintain O 2 saturation 93% Ted hose Metaprolol 50mg po bid Lisinopril 5mg po qd Repeat BUN, creatinine, electrolytes in am Maintain strict I&O
26 Case Study 2 Admission Review (Episode Day 1) 7/21/
27 Case Study 2 Admission Review (Episode Day 1) 7/21/
28 Case Study 2 Admission Review (Episode Day 1) 7/21/
29 Case Study 2 Continued Stay Review (Episode Day 2) Mary s condition remained stable overnight. She continues to receive 0 2 at 2L/min, HR is WNL, and there are no changes to her medications. Repeat BUN: 40, creatinine: 1.5
30 Case Study 2 Continued Stay Review (Episode Day 2) 7/21/
31 Case Study 2 Continued Stay Review (Episode Day 3) Today Mary s vital signs are stable, O 2 sat has improved to 93% on RA, and she has trace bilateral pedal edema. Repeat BUN: 46, creatinine: 1.8 Medical Practitioner Orders: Discontinue oxygen Change furosemide to bumetanide 1.0mg PO qd Renal consult has been ordered
32 Case Study 2 Continued Stay Review (Episode Day 3)
33 Case Study 2 Continued Stay Review (Episode Day 4) Overnight Mary remained stable. She was evaluated by a nephrologist yesterday. Testing and follow-up has been scheduled as an outpatient. Today BUN and creatinine improving: 43 and 1.6 Medical Practitioner Orders: Discharge to home Schedule follow-up with PCP for this week Outpatient testing scheduled
34 Case Study 2 Continued Stay Review (Episode Day 4)
35 Agenda Introducing Condition Specific Subsets Case Study 1: Pediatrics Criteria / Book View Q&A Case Study 2: Adult Criteria / Software View Support for Transition Q&A 35
36 Support for Transition to 2011 Acute Criteria What Where When How Acute Level of Care Demonstration (Flash) MHS Customer Hub DLC Now April 1 Download Free webinars MHS Customer Hub Demo (repeat of today) Case Studies 1 Case Studies 2 Ask the Expert Online/phone March 9 March 29 April 28 May 24 June 22 invitations Review process InterQual Book/ Software April 1 Book: Tab Software: Help Acute Criteria 2011 Training ½ day (fees apply) San Francisco Boston April 14 June 23 Look for in March Acute Criteria 2011 Training (fees apply) Online plus onsite or virtual live training Beginning April 18 Contact account manager 36
37 Getting a Password for MHS Customer Hub: Self-Registration 1. Go to the MHS Customer Hub login page 2. Click Need a User ID and Password? 3. Enter your address 37
38 Demo on MHS Customer Hub 7/21/
39 Agenda Introducing Condition Specific Subsets Demonstration Case Study 1: Pediatrics Criteria / Book View Q&A Case Study 2: Adult Criteria / Software View Support During Transition Q&A 39
40 Contact Us McKesson and InterQual , option 1 McKesson Twitter: McKesson_MHS
41 Appendix 2010 Heart Failure Criteria 2011 Heart Failure Criteria 41
42 2010 Heart Failure Criteria Severity of Illness Intensity of Service ACUTE, ONE: CHF and hemodynamic stability, One: O2 sat < 89%(0.89) Arterial Po2< 56 mmhg(7.5 kpa) Sustained heart rate /min ACUTE, ONE: CHF and O2 sat < 91%(0.91) requiring supplemental O2 3d, All: ACE Inhibitor / ARB (includes PO), administration / contraindication Beta blocker (includes PO), administration / contraindication Cardiac monitoring, continuous (excludes Holter) Diuretic(s) administration DVT prophylaxis 42
43 2011 Heart Failure Criteria SI (ADMISSION) EPISODE DAY 1 OBSERVATION ACUTE, BOTH: Finding, One: O2 sat < 89% (0.89), arterial Po2 < 56 mmhg Sustained heart rate /min Treatment, All: Oxygen to maintain O2 sat 92% or baseline Oximetry or blood gas ACE Inhibitor or ARB (includes PO), administered or contraindicated Beta blocker (includes PO), administered or contraindicated Cardiac monitoring, continuous (excludes Holter) Diuretic doses DVT prophylaxis or patient ambulatory INTERMEDIATE CRITICAL 43
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