Interqual? - page 3

Just wondering what exactly this is. I think is has to do with determining acuity of care but would like to see what case managers in the industry define it as. Thanks, Ginger... Read More

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    Interqual is proprietary program...need to pay for access to site/book.

    The Birth of InterQual: Evidence-Based Decision Support Criteria That Helped Change Healthcare
    A. Jacqueline Mitus MD

    Professional Case Management
    July/August 2008
    Volume 13 Number 4
    Pages 228 - 233

    Purpose/objectives: InterQual evidence-based clinical decision support criteria are used by thousands of organizations in healthcare. What industry trends led to their creation, and what accounts for their longevity and widespread acceptance?

    Primary practice settings(s): Hospitals, health systems, and managed care organizations.

    Findings/conclusions: Although the healthcare puzzle sometimes seems too complicated for anyone to solve, passionate people with good ideas have been able to effect substantive and relatively rapid change throughout healthcare history.

    Implications for case management practice:

    1. Prior to the general use of consistent and rigorous utilization management, widespread care variations, excessive healthcare costs, and less-than-optimal care were the rule rather than the exception.

    2. Strategically and methodically overcoming resistance to change—starting small and the expanding outward—is the key component in reinventing healthcare.

    3. In the end, if a process does not make sense, it needs to change. Take on that responsibility, joining with like-minded individuals to build momentum.
    JerseyLilly likes this.

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    IQ is not very patient friendly, that's for sure, and that's what we use at our hospital, however when a patient doesn't meet the criteria, our physician advisor overrides the criteria. Everyone including Medicare knows that the criteria is not always appropriate. It gives McKesson a good laugh every day, though. They also run Comedy Central!
    It's an expensive program we're all subjected to.
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    I've done bedside nursing in a hospital setting for 15 years now and I was just offered the chance to step into a patient care coordinator position. I think I'm very good at interpersonal relationships, but it's all the other stuff like Interqual that I'm worried about... and making the right decisions. Is there anything I can do to assure my success? Or is it totally an experience thing?
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    I have trained many nurses from the floors. In my opinion, as long as you have a good clinical background for the area you will case manage or coordinate, you'll be ok. Interqual will be another thing your trainer will show you how to use. Ours is built into our computer system. If not, you will be provided a book as a reference. Good luck!
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    Quote from Ginger35
    Just wondering what exactly this is. I think is has to do with determining acuity of care but would like to see what case managers in the industry define it as.


    Interqual is used quite a is based from the severity of the illness ( SI) and intensity of the service (IS) . I find this better than some , like the Milliman & Robertson. there are yearly updates too , so your facility should have the most current. Not all hospitals use Interqual..... The funny thing about it though is that there are hospitals (in their case mgmt.) who claims to use the Interqual, and yet the case manager supervisor can not produce any book of Interqual when I asked for it! I have heard that it is expensive........but if they do not have the guideline, how can they follow it correctly? These are one of the reasons that I got out and will stay out from case managing, (hospital base)---they expect you to do somethng wonderful and yet they won't supply you w/ the right tools!!! It is a wonderful position if staff, doctors, & admitting personnel work adhesively and well. this is the key........
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    New book that is used at our small Hsp. is small and affordable
    Standard Hospital Admission Criteria (SHAC) $9.99
    We use this when someone is admitted from the emergency room.
    find it on web-site
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    Just looking at this thread because I had seen a Case management position available and it mentioned Interqual.

    In this

    I take Remicaid for my RA, and developed a severe Pyelo. I had >18,000 wbc, fever >105 (Mckesson rounds up 1 degree for core body temp), hematuria and pyuria, and I'm immunocompromised, and I still didn't get admitted, cuz I could still take po (barely), wasn't vomiting, and succeeded at OP tx

    If so much relies on meeting all the criteria, and you were clearly unwell enough clinically (IMO and many others) , if you could barely take PO why do the staff not put up an IV to supplement your hydration which is bound to be inadequate when you are feeling so ill and would also speed up your recovery, especially considering your type of illness.

    Now I am beginning to understand why readmission rates are so high. I am thinking you are fairly young, but if it had been someone who was 75 they could have gone home and died, or been admitted with full blown sepsis needing critical care

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