Utilization Review

Download the following worksheet regarding utilization review at the hospital and complete both Parts I and II as indicated.

Utilization Review

The Utilization Review Assignment consists of 2 parts. In part 1 you will be given a list of criteria. You will label each criteria as "intensity of service" (IS) or "severity of illness" (SI). For part 2 you will be given 3 patient scenarios. You are to determine whether or not the patient should remain in the hospital or be discharged.

Part 1 of the assignment. When you think of “intensity of service”, think of a service being performed by a nurse or doctor. Is the patient given medication? Is the patient being monitored or need assistance? “Severity of illness” is how sick the patient is. Think in terms of what is going on within the body.

For part 2 of the assignment. When you read each scenario, try to pick out the closely-related criteria indicator in that scenario from part 1 (the criteria indicator may not be exactly what is found in part 1 but it is quite close). The criteria from part 1 indicates that the patient needs to stay in the hospital a little longer. If there is no criteria indicator found, you will put none in the criteria column, discharge that patient, and you will send the discharge form to the doctor for the action. If there is a criteria indicator that is found, you will put the criteria from the scenario in the column, the patient will continue to stay in the hospital and you will have no action.