Vol. 114, July Printed in
THE JOURNAL OF UROLOGY
Copyright © 1975 by The Williams & Wilkins Co.
A TECHNIQUE FOR PEER REVIEW DAVID A. CULP From the Department of Urology, University of Iowa, Iowa City, Iowa
Professional Standard Review has become a law to which each physician must comply regardless of his or her opinion of it. At this time its only thrust is cost containment but the idea of peer review which it embodies has been a concept long used by the medical profession to improve the knowledge of individual physicians and medical institutions involved in the delivery of medical care. Therefore, it is our responsibility, while the program remains in its formative stage, to construct individual programs in such a manner as to satisfy the requirements of the federal government and also to enhance the quality of medical care. Our primary concern should be for the health of our patients rather than the financial well-being of Blue Cross, Blue Shield, private insurance or the federal government. The welfare of the sick must continue to be measured in humanitarian rather than financial terms. Medicine controlled an external authoris accountable to no one. To this end the Department of Urology at the University of Iowa has devised and used during the last 6 months a computerized program to meet these demands. With the aid of our section on systems development we have constructed a computer program to record the admission data required by the Bennett amendment and also simultaneously provide information for our Utilization Review Committee. While a computerized program is ultimately timesaving, it is not essential for the function of the program. The principles upon which the program is based are most important. We herein present this material in the hope that it may be of some assistance to others struggling with these same problems. Initially we developed a list of hospitalization criteria for each urological diagnosis similar to that recently compiled and distributed the Professional Relations Committee of the American Urological Association. However, it soon became obvious that such a compilation would be massive, repetitive, cumbersome and restrictive to be used effectively. Therefore, we attempted to reduce its magnitude lumping similar disease processes together. Even this consolidation produced a bulky, unwieldy document that was difficult to use. At this point we decided to approach the problem from another direction, recognizing that we really do not hospitalize because they have disease but because disease produces
symptoms or abnormalities that require hospitalization. We listed all the reasons for admitting a patient to the hospital and found that by using broad categories, such as abnormalities in rather than each individual alteration in micturition, we were able to devise a much more workable document. Using this format we have designed a form for recording 1) demographic information, 2) tentative diagnosis or problem, 3) indexes for admission, 4) admission priority and 5) facilities required 1). This form is completed by the physician at the time the patient is admitted to the hospital and entered into the computer program a secretary from terminals conveniently located in the outpatient clinic area. To avoid one of the major tions of physicians to the Professional Standards Review Organization program we have titled this form Documentation of Need for Admission and not Preadmission Certification. The physician is the only one who should decide when it is necessary for the patient to be admitted to the hospital. However, documentation of the need for hospitalization is necessary, particularly since a disinterested third party is becoming more and more for paying the bill. U'J !VERSITY OF tmiA HOSPITALS AND Cl IN!CS
DEPARTMENT OF UROLOGY
IJOJ.l'CNTAT!ON Cf NEED FOR All"IISS!ll'l Date
ofReQl.l'est__ _
at1entNuiiiEer--· lentat1ve D 1 a g n o S T s ~ - - - - - - - · - - -
~eRev'er5~-
IN0ICA1 JONS FOR ADMIS5li'ilf_________ - - - - - - - ___ _j____ ___ ---0001 0002 0003 0004 0005 0006 0007 __ 0008
Lesion interfering with renal function Lesion altering function of urinary or genital transport system Genitourinary tract trauma Benign or maligriant neoplasms Infection or inflarrmation. Abnormalities of the urine. Abnorrra 1i ties of voiding Abdominal, flank, pelvic or genital pain.
0009 0010
Abdominal, flank, pelvic or genital mass. Congenital genitourinary tract anomalies
0011
Metabolic or honnonal abnonnalities
0012 0013
Mal function secondary to neurologi c disease Unexplained syirptoms or signs expressed in genitourindry tract
ADMISSION PRIORJTY Errergency
Accepted for publication November 22, 1974. Read at annual meeting of North Central Section, American Urological Association, Columbus, Ohio, September 18-21, 1974.
FACll!TlES REQUIRED Oxygen
Urgent (24 hours)
Isolation
Semi urgent ( 72 hours)
Private Bath
Elective
Other _ _ _ _ _ _ _ _ _ _
Admitting Physician
FIG. 1. Documentation of need for admission form 111
112
CULP
Once this information is entered into the program a length of stay standard days is assigned according to the tentative diagnosis. The length of stay standard figure was obtained by analyzing the length of stay in our hospital for each diagnosis during the preceding year, and then selecting the seventy-fifth percentile stay as the standard. In some cases insufficient information was available to arrive at an accurate length of stay standard figure . However, as additional information is added each year it will become more and more reliablf'. Based upon the length of stay standard a utilization review process is initiated 2 days before the time when the patient's hospital stay standard is reached. A computer printout is obtained which provides 1) demographic information , 2) the length of patient stay, 3) the length of stay standard for that particular problem, 4) the information submitted on the Documentation of Need for Admission form, 5) a list of complications that extend the length of stay, 6) a place for the physician to extend the length of stay standard and 7) a place for the attending and reviewing physicians to sign the form after they have acted upon the matter (fig. 2). If the patient is ready for discharge from the hospital the attending physician simply enters this information along with his signature . However, if the patient is not ready for release from the hospital, the attending physician identifies the reason and estimates the additional time that will be necessary for the patient's recovery . When the attending physician has completed his review the form is sent to a physician member of the Utiliza-
UNIVER SIH OF IOWA HOSPITALS AND CLI NIC S
APR 24,1974
DAYS STAY EXCEPTION REPOR T
PAGE
I
ATTE'W !N t> PHYSICIA N - DR. RAYMOND G. BUNG E DEPARTMENT OF UROLOGY
74- 00228
BOLDER, J IM
AGE - 21
URGEN T 04/16/74 DAYS SI NC E ADM. - 7 LENGTH OF STAY STD DAYS - 5 TOTAL DAYS EXTENDED - 4
TE"lT ATJ VE DI AGNOSI S OR PROBL EM· UREniRITIS / NONSPE CJFIC ( A597.0l) I NDICATION FOR ADMISSION: J'ISNOR"VIL ITl ES OF THE UR !N E (0008) ABOO MINAL, FLANK, PELVI C OR GENITAL PAIN (0010) DATE OF LAST EXTENSION - 04 / 22/74 ~ EXTENSJON DAYS - 4 REASON FOR EXTENSION: PA IN OR DISCOMFORT UNCCtHROLLED WITH MILD ANALGE SI CS I NDI CAT ION FOR EXTENSION- ________ ___ _ # Days - _____ BEGINNING ___ !___! __ _
COMPll CATIONS THAT EXTEND TKE LENGTH OF STAY· 000 1 00')2
'l003 0004 000 5 0006 000 7 0008 O'J09 00 11) 00 11 00 12
PERSISTENT OR Lt/CONTRO LLED GE NITOU RINARY TRACT INFECTIO N. CO MPLICATI NG INFECTION IN OTHER BODY SYSTEMS OR CAVITIES. PER SI STENT URINARY FISTIJ..A OR EXTRAVASATI OO . [HAY ED WOUND HEALING . SECONDARY HEMOR~AGE OR HEMATURIA. RE CURRE NT GE NITOURINARY TRACT OBST RUCTI ON . PERSISTE NT OR PROGRESSIVE LOSS OF RENAL FUNCTION. PRCBLE MS lol!TH DIVERT ING CATHETERS OR CCU ECTING DE VI CES. PAI~ OR DISCOMFORT UNCONTROLLED WI TH MILD ANALGESICS. ~B il !TAT!ON - POOR OR SLOW RECOVERY OR STRENGTH ANO VIGOR. RELATE D ~ UNRELATED DISEASE IN QTI,ER BODY SYSTEMS. LOCAL OR SYSTEMIC REACTJONS TO THERAPEUTIC MEASURES.
ATTENDING PHYSI C!AN
REVI EWI NG PHYS I CIAN ~ ~- --
- -- -
M. D.
DATE _
_
_
_
_
M. 0 .
DATE _ __
_
_
FIG. 3. Form notifying attending physician that patient's stay approaches previously granted extension of hospital stay. L.NIY ERSI TY OF IOWA HOSPITAL S AND CLINICS
APR 22, 1974
DAYS STAY EXCEPTION REPO RT
PAGE
I
ATTENDING PHYSICIAN - OR. RAYltOND G. B!.MGE DEP ARTMENT OF UROLOGY 74-00228
BOLDER, JIM
Ali: • 21 URGENT 04/16/74 ~YS SINCE ADM . 5 LENGTH OF STAY STD DAYS - 5
TE NTATIVE DIAGNOSIS OR PROBLEM : URETHRITI S/NONSPEC IFI C (A597 .01)
UNIVERSITY OF I OWA HOSP ITALS AND CLINICS
APR 20,1974
DAY S STAY EX(EPTIOO REPORT
PAG[
l
ATTENDING PHYSICIA N - DR . RA YMOND G. BUN GE DEPARTMENT OF UROLOGY
AGE - 21
URGENT 04/1 6/7 4 DAYS SIN CE ADM. - 3 LENGTH OF STAY STD DAYS - 5
TE NTATIVE DIAGNOSIS OR PROBLEM: URETHRITI S/NONSPECIFIC ( A597. 0 l ) IND ICAT!ON FOR ADMISSIO"i : ABNORJi'ALITIES OF THE URINE (0008) ABDOMINAL, FL AN K, PEL VIC OR GENITAL PAIN (O'JlO)
~ DAYS-----
BEG INNING __ _/ __ J
PERS ISTENT OR UNCONTROLLED GENJTO UIHNARY TRACT INFE CT ION. COMPLICATING INFECTJON IN OTHER BODY SYSTE MS OR CAVITIES . PERSISTENT URI NARY FISTULA OR EXTRAVASA TJON. [HAY ED WOUND HEALING. SECONDARY HEMORRHAGE OR HEM.ATURIA . RECURRENT GENITOURINARY TRACT OBSTRUCTION. PERS I STENT OR PROGRESSIVE LOSS OF RENAL FUNCTION PROB LEMS WJTI, DIVERTING CATHETERS OR COLLECTING DEVI CE S. PAIN OR DISCOMFORT Lt/CONTROLLED W!TH MIL D ANALGESI CS. OCBIL ITATJON - POOR OR SLOW RECOVERY OR STREN GTH ANO VIGOR RELATED OR UNRELATED DISEASE IN OTHER BODY SYSTE MS. LOCAL OR SYSTEMI C REACTIONS TO THEAAPE UTIC MEASURES.
ATTENDI NG PHYSICIAN _
_ __ __
REV!EW!NG PH YSICIAN _
_
_
_
_
_ __
_ __
_ M. O.
_ __ _ ,M.O.
PERS I STE NT OR UNCONTROL LED !i:N ITOURIN ARY TR.ACT INFECTION. COl'l'l JCATI NG INFECTI ON IN QTI,ER BOOY SYSTEMS OR CAVITIES. PERSISTENT UR INARY FJ STLLA OR EXTRAVASATION. {HAYED WOUND HEAL ING. SECO NDARY HEJIORRHAGE OR HE~TURIA. Rf CURRENT GENITOURINARY TR ACT OBSTRUCTION. PERS I STENT OR PROGRESSIVE LOSS OF RfNAl Flt/CTION . PJUBLEMS WITH DI VER TJNG CA THETERS OR COLLECTI NG DEVICES . PAIN OR DISCOMFORT UNCONTROLLED WITH MILO ANALGESICS. OCBILITAT!ON - POOR OR SLOW RECOVERY OR ST REN GTH ANO VIGOR. RELATED OR L.NRELATE D DISEASE IN OTHER SOOY SYSTEMS. LOCAL OR SYSTE MIC REACTIONS TO THEAAPEUTIC MEA SURES.
ATTENDING PHYS I CIAN _
_
_
_
_
_ __
_ _ M.0 .
DATE _ __ __
REVIEWIN G PH YSICI AN _
_
_
_
_ __ __
_ _M. 0.
DATE _
.
_
_ __
_
.
" DEL l NOU E NT"
FIG. 4. Delinquent form notifying attending physician that patient's stay has reached length of stay standard.
DATE _ __
OAT( _
0001 0002 0003 0004 0005 0006 0007 0008 0009 0010 0011 0012
__ _
COMPLICATIONS THAT EXTEND THE LENGTH OF STAY :
000 1 0002 000 3 0004 0005 0006 000 7 000 8 0009 0010 00 11 00 12
AOM. CRI TERIA f'E T? INDICATION FOR EXTENSIOO- - - - · ---- - · ----- # DAYS- _____ 8EGINNING __ _/ __ _/ __ _ COMPLICATIONS TKAT EXTEND Tl-IE LENGTH OF STAY;
74-0 0228 BOLDER , JI M
ADM. CRI TERIA MET ? - --IN D!CAT I ON FOR EXTENSION-
IND ICATI!Jl FOR ADMISSION: ABNORJi'ALITIES OF Tl-IE URINE (0008) ABOOMINAL, FLANK, PELVIC OR GENITAL PA[N (0010)
_
_
_ __
FIG. 2. Form notifying attending physician that patient's stay approaches length of stay standard.
tion Review Committee for action. At the same time the information from this form is entered into the computer program . When the patient's length of stay has been extended a new printout will appear 2 days be-
TECHNIQUE FOR PEER REVIEW
fore the expected date of discharge from the hospital, which is determined by the original length of stay standard plus the attending physician's estimate of the additional time necessary for recovery (fig. 3). The process will repeat itself each time the patient's stay is extended. If, for one reason or another, the length of stay standard is reached, a similar printout appears but with a delinquent mark at the bottom of the form (fig. 4). One of the distinct features of the program is that it provides individual utilization review rather than selecting an over-all average time for the patient's stay in a given hospital. As more and more experience is achieved the length of stay standard will reflect the number and degree of complications for each disease process.
113
We have had the opportunity to use this program for the last 6 months, and the professional urological staff and the Utilization Review Committee have found it to be completely satisfactory. In fact, we are hoping to extend the program in a similar manner to include the diagnostic and therapeutic hospital events, which will then permit a quality review of the patient's care as well. There is little doubt that further attempts will be made to bring the medical profession under complete control of the federal bureaucracy. Therefore, it is our duty as physicians to regulate our own affairs, individually and corporately, through our local institutions, medical societies and associations in such a way that it will be acceptable to our changing society.
THE JOURNAL OF UROLOGY
Copyright © 1975 by The Williams & Wilkins Co.
A TECHNIQUE FOR PEER REVIEW DAVID A. CULP From the Department of Urology, University of Iowa, Iowa City, Iowa
Professional Standard Review has become a law to which each physician must comply regardless of his or her opinion of it. At this time its only thrust is cost containment but the idea of peer review which it embodies has been a concept long used by the medical profession to improve the knowledge of individual physicians and medical institutions involved in the delivery of medical care. Therefore, it is our responsibility, while the program remains in its formative stage, to construct individual programs in such a manner as to satisfy the requirements of the federal government and also to enhance the quality of medical care. Our primary concern should be for the health of our patients rather than the financial well-being of Blue Cross, Blue Shield, private insurance or the federal government. The welfare of the sick must continue to be measured in humanitarian rather than financial terms. Medicine controlled an external authoris accountable to no one. To this end the Department of Urology at the University of Iowa has devised and used during the last 6 months a computerized program to meet these demands. With the aid of our section on systems development we have constructed a computer program to record the admission data required by the Bennett amendment and also simultaneously provide information for our Utilization Review Committee. While a computerized program is ultimately timesaving, it is not essential for the function of the program. The principles upon which the program is based are most important. We herein present this material in the hope that it may be of some assistance to others struggling with these same problems. Initially we developed a list of hospitalization criteria for each urological diagnosis similar to that recently compiled and distributed the Professional Relations Committee of the American Urological Association. However, it soon became obvious that such a compilation would be massive, repetitive, cumbersome and restrictive to be used effectively. Therefore, we attempted to reduce its magnitude lumping similar disease processes together. Even this consolidation produced a bulky, unwieldy document that was difficult to use. At this point we decided to approach the problem from another direction, recognizing that we really do not hospitalize because they have disease but because disease produces
symptoms or abnormalities that require hospitalization. We listed all the reasons for admitting a patient to the hospital and found that by using broad categories, such as abnormalities in rather than each individual alteration in micturition, we were able to devise a much more workable document. Using this format we have designed a form for recording 1) demographic information, 2) tentative diagnosis or problem, 3) indexes for admission, 4) admission priority and 5) facilities required 1). This form is completed by the physician at the time the patient is admitted to the hospital and entered into the computer program a secretary from terminals conveniently located in the outpatient clinic area. To avoid one of the major tions of physicians to the Professional Standards Review Organization program we have titled this form Documentation of Need for Admission and not Preadmission Certification. The physician is the only one who should decide when it is necessary for the patient to be admitted to the hospital. However, documentation of the need for hospitalization is necessary, particularly since a disinterested third party is becoming more and more for paying the bill. U'J !VERSITY OF tmiA HOSPITALS AND Cl IN!CS
DEPARTMENT OF UROLOGY
IJOJ.l'CNTAT!ON Cf NEED FOR All"IISS!ll'l Date
ofReQl.l'est__ _
at1entNuiiiEer--· lentat1ve D 1 a g n o S T s ~ - - - - - - - · - - -
~eRev'er5~-
IN0ICA1 JONS FOR ADMIS5li'ilf_________ - - - - - - - ___ _j____ ___ ---0001 0002 0003 0004 0005 0006 0007 __ 0008
Lesion interfering with renal function Lesion altering function of urinary or genital transport system Genitourinary tract trauma Benign or maligriant neoplasms Infection or inflarrmation. Abnormalities of the urine. Abnorrra 1i ties of voiding Abdominal, flank, pelvic or genital pain.
0009 0010
Abdominal, flank, pelvic or genital mass. Congenital genitourinary tract anomalies
0011
Metabolic or honnonal abnonnalities
0012 0013
Mal function secondary to neurologi c disease Unexplained syirptoms or signs expressed in genitourindry tract
ADMISSION PRIORJTY Errergency
Accepted for publication November 22, 1974. Read at annual meeting of North Central Section, American Urological Association, Columbus, Ohio, September 18-21, 1974.
FACll!TlES REQUIRED Oxygen
Urgent (24 hours)
Isolation
Semi urgent ( 72 hours)
Private Bath
Elective
Other _ _ _ _ _ _ _ _ _ _
Admitting Physician
FIG. 1. Documentation of need for admission form 111
112
CULP
Once this information is entered into the program a length of stay standard days is assigned according to the tentative diagnosis. The length of stay standard figure was obtained by analyzing the length of stay in our hospital for each diagnosis during the preceding year, and then selecting the seventy-fifth percentile stay as the standard. In some cases insufficient information was available to arrive at an accurate length of stay standard figure . However, as additional information is added each year it will become more and more reliablf'. Based upon the length of stay standard a utilization review process is initiated 2 days before the time when the patient's hospital stay standard is reached. A computer printout is obtained which provides 1) demographic information , 2) the length of patient stay, 3) the length of stay standard for that particular problem, 4) the information submitted on the Documentation of Need for Admission form, 5) a list of complications that extend the length of stay, 6) a place for the physician to extend the length of stay standard and 7) a place for the attending and reviewing physicians to sign the form after they have acted upon the matter (fig. 2). If the patient is ready for discharge from the hospital the attending physician simply enters this information along with his signature . However, if the patient is not ready for release from the hospital, the attending physician identifies the reason and estimates the additional time that will be necessary for the patient's recovery . When the attending physician has completed his review the form is sent to a physician member of the Utiliza-
UNIVER SIH OF IOWA HOSPITALS AND CLI NIC S
APR 24,1974
DAYS STAY EXCEPTION REPOR T
PAGE
I
ATTE'W !N t> PHYSICIA N - DR. RAYMOND G. BUNG E DEPARTMENT OF UROLOGY
74- 00228
BOLDER, J IM
AGE - 21
URGEN T 04/16/74 DAYS SI NC E ADM. - 7 LENGTH OF STAY STD DAYS - 5 TOTAL DAYS EXTENDED - 4
TE"lT ATJ VE DI AGNOSI S OR PROBL EM· UREniRITIS / NONSPE CJFIC ( A597.0l) I NDICATION FOR ADMISSION: J'ISNOR"VIL ITl ES OF THE UR !N E (0008) ABOO MINAL, FLANK, PELVI C OR GENITAL PAIN (0010) DATE OF LAST EXTENSION - 04 / 22/74 ~ EXTENSJON DAYS - 4 REASON FOR EXTENSION: PA IN OR DISCOMFORT UNCCtHROLLED WITH MILD ANALGE SI CS I NDI CAT ION FOR EXTENSION- ________ ___ _ # Days - _____ BEGINNING ___ !___! __ _
COMPll CATIONS THAT EXTEND TKE LENGTH OF STAY· 000 1 00')2
'l003 0004 000 5 0006 000 7 0008 O'J09 00 11) 00 11 00 12
PERSISTENT OR Lt/CONTRO LLED GE NITOU RINARY TRACT INFECTIO N. CO MPLICATI NG INFECTION IN OTHER BODY SYSTEMS OR CAVITIES. PER SI STENT URINARY FISTIJ..A OR EXTRAVASATI OO . [HAY ED WOUND HEALING . SECONDARY HEMOR~AGE OR HEMATURIA. RE CURRE NT GE NITOURINARY TRACT OBST RUCTI ON . PERSISTE NT OR PROGRESSIVE LOSS OF RENAL FUNCTION. PRCBLE MS lol!TH DIVERT ING CATHETERS OR CCU ECTING DE VI CES. PAI~ OR DISCOMFORT UNCONTROLLED WI TH MILD ANALGESICS. ~B il !TAT!ON - POOR OR SLOW RECOVERY OR STRENGTH ANO VIGOR. RELATE D ~ UNRELATED DISEASE IN QTI,ER BODY SYSTEMS. LOCAL OR SYSTEMIC REACTJONS TO THERAPEUTIC MEASURES.
ATTENDING PHYSI C!AN
REVI EWI NG PHYS I CIAN ~ ~- --
- -- -
M. D.
DATE _
_
_
_
_
M. 0 .
DATE _ __
_
_
FIG. 3. Form notifying attending physician that patient's stay approaches previously granted extension of hospital stay. L.NIY ERSI TY OF IOWA HOSPITAL S AND CLINICS
APR 22, 1974
DAYS STAY EXCEPTION REPO RT
PAGE
I
ATTENDING PHYSICIAN - OR. RAYltOND G. B!.MGE DEP ARTMENT OF UROLOGY 74-00228
BOLDER, JIM
Ali: • 21 URGENT 04/16/74 ~YS SINCE ADM . 5 LENGTH OF STAY STD DAYS - 5
TE NTATIVE DIAGNOSIS OR PROBLEM : URETHRITI S/NONSPEC IFI C (A597 .01)
UNIVERSITY OF I OWA HOSP ITALS AND CLINICS
APR 20,1974
DAY S STAY EX(EPTIOO REPORT
PAG[
l
ATTENDING PHYSICIA N - DR . RA YMOND G. BUN GE DEPARTMENT OF UROLOGY
AGE - 21
URGENT 04/1 6/7 4 DAYS SIN CE ADM. - 3 LENGTH OF STAY STD DAYS - 5
TE NTATIVE DIAGNOSIS OR PROBLEM: URETHRITI S/NONSPECIFIC ( A597. 0 l ) IND ICAT!ON FOR ADMISSIO"i : ABNORJi'ALITIES OF THE URINE (0008) ABDOMINAL, FL AN K, PEL VIC OR GENITAL PAIN (O'JlO)
~ DAYS-----
BEG INNING __ _/ __ J
PERS ISTENT OR UNCONTROLLED GENJTO UIHNARY TRACT INFE CT ION. COMPLICATING INFECTJON IN OTHER BODY SYSTE MS OR CAVITIES . PERSISTENT URI NARY FISTULA OR EXTRAVASA TJON. [HAY ED WOUND HEALING. SECONDARY HEMORRHAGE OR HEM.ATURIA . RECURRENT GENITOURINARY TRACT OBSTRUCTION. PERS I STENT OR PROGRESSIVE LOSS OF RENAL FUNCTION PROB LEMS WJTI, DIVERTING CATHETERS OR COLLECTING DEVI CE S. PAIN OR DISCOMFORT Lt/CONTROLLED W!TH MIL D ANALGESI CS. OCBIL ITATJON - POOR OR SLOW RECOVERY OR STREN GTH ANO VIGOR RELATED OR UNRELATED DISEASE IN OTHER BODY SYSTE MS. LOCAL OR SYSTEMI C REACTIONS TO THEAAPE UTIC MEASURES.
ATTENDI NG PHYSICIAN _
_ __ __
REV!EW!NG PH YSICIAN _
_
_
_
_
_ __
_ __
_ M. O.
_ __ _ ,M.O.
PERS I STE NT OR UNCONTROL LED !i:N ITOURIN ARY TR.ACT INFECTION. COl'l'l JCATI NG INFECTI ON IN QTI,ER BOOY SYSTEMS OR CAVITIES. PERSISTENT UR INARY FJ STLLA OR EXTRAVASATION. {HAYED WOUND HEAL ING. SECO NDARY HEJIORRHAGE OR HE~TURIA. Rf CURRENT GENITOURINARY TR ACT OBSTRUCTION. PERS I STENT OR PROGRESSIVE LOSS OF RfNAl Flt/CTION . PJUBLEMS WITH DI VER TJNG CA THETERS OR COLLECTI NG DEVICES . PAIN OR DISCOMFORT UNCONTROLLED WITH MILO ANALGESICS. OCBILITAT!ON - POOR OR SLOW RECOVERY OR ST REN GTH ANO VIGOR. RELATED OR L.NRELATE D DISEASE IN OTHER SOOY SYSTEMS. LOCAL OR SYSTE MIC REACTIONS TO THEAAPEUTIC MEA SURES.
ATTENDING PHYS I CIAN _
_
_
_
_
_ __
_ _ M.0 .
DATE _ __ __
REVIEWIN G PH YSICI AN _
_
_
_
_ __ __
_ _M. 0.
DATE _
.
_
_ __
_
.
" DEL l NOU E NT"
FIG. 4. Delinquent form notifying attending physician that patient's stay has reached length of stay standard.
DATE _ __
OAT( _
0001 0002 0003 0004 0005 0006 0007 0008 0009 0010 0011 0012
__ _
COMPLICATIONS THAT EXTEND THE LENGTH OF STAY :
000 1 0002 000 3 0004 0005 0006 000 7 000 8 0009 0010 00 11 00 12
AOM. CRI TERIA f'E T? INDICATION FOR EXTENSIOO- - - - · ---- - · ----- # DAYS- _____ 8EGINNING __ _/ __ _/ __ _ COMPLICATIONS TKAT EXTEND Tl-IE LENGTH OF STAY;
74-0 0228 BOLDER , JI M
ADM. CRI TERIA MET ? - --IN D!CAT I ON FOR EXTENSION-
IND ICATI!Jl FOR ADMISSION: ABNORJi'ALITIES OF Tl-IE URINE (0008) ABOOMINAL, FLANK, PELVIC OR GENITAL PA[N (0010)
_
_
_ __
FIG. 2. Form notifying attending physician that patient's stay approaches length of stay standard.
tion Review Committee for action. At the same time the information from this form is entered into the computer program . When the patient's length of stay has been extended a new printout will appear 2 days be-
TECHNIQUE FOR PEER REVIEW
fore the expected date of discharge from the hospital, which is determined by the original length of stay standard plus the attending physician's estimate of the additional time necessary for recovery (fig. 3). The process will repeat itself each time the patient's stay is extended. If, for one reason or another, the length of stay standard is reached, a similar printout appears but with a delinquent mark at the bottom of the form (fig. 4). One of the distinct features of the program is that it provides individual utilization review rather than selecting an over-all average time for the patient's stay in a given hospital. As more and more experience is achieved the length of stay standard will reflect the number and degree of complications for each disease process.
113
We have had the opportunity to use this program for the last 6 months, and the professional urological staff and the Utilization Review Committee have found it to be completely satisfactory. In fact, we are hoping to extend the program in a similar manner to include the diagnostic and therapeutic hospital events, which will then permit a quality review of the patient's care as well. There is little doubt that further attempts will be made to bring the medical profession under complete control of the federal bureaucracy. Therefore, it is our duty as physicians to regulate our own affairs, individually and corporately, through our local institutions, medical societies and associations in such a way that it will be acceptable to our changing society.
