Interqual? - page 2

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

  1. by   CaseManager1947
    Havn' A Party--They have a web site for folks who have shelled out the big bucks for a contract w/them. I have some old books (i can't seem to throw anything away). PM me if you want last years... it'd be better than nothing.
  2. by   rwag63
    I was wondering if anyone has the 2008 Acute care guidelines? Is kyphoplasty still listed as appropriate for the inpatient setting?
  3. by   CaseManager1947
    I can't find my 2008 book, but in 2007, under CNS/musculoskeletal, imaging findings say " Compression fx and ileus. So to meet IP criteria, pt. would need another clinical severity of illness indicator... eg. cardiac problem (dysrhythmia) or perhaps withdrawal syndrome. PO meds are excluded on nearly all the screens for these Now, do we see little old ladies/men with compression fx needing kyphoplasty as an IP? Sure, all the time.
    The book is helpful, but lots of times in order to meet, ya gotta be darn near dead.
  4. by   edgwow
    Interqual on a medical floor is like fitting a square peg in a round hole, especially a transplant workup patient. You can not control when it "just doesn't meet". I gaurentee you that it is always more difficult to make them fit inpt. criteria after 3 PM.You will talk to yourself, nod your head and this will continue to happen. Do not worry, it is normal. I guess that's because you've probably done 15 other reviews and are still trudging on. Long live the NIghtmare of Interqual!!!!!!!!!!
  5. by   edgwow
    Hey, Thanks
    I am going to print this up and post it on my bulletin board in front of my workstation. I didn't admit them, and I just go by the criteria. If you read my post further down, I am disillusioned by the interqual and the criteria. I hate having to task 5-8 cases a day to the physician advisor, and I especially hate when the insurance company calls more than twice for additional information.
  6. by   cap45
    Where can you get this book or software?
  7. by   Katie82
    I worked for a MCO that managed Medicaid patients. We were trained in Interqual, but I rarely used it in my job. THe UM people used it more than Case Management, but the company didn't demand usage. I found that the software was not totally user-friendly(for the application we used) and I often found it was difficult to apply the criteria to my patients - too many variables with my folks. I think the only thing I found it useful for was evaluating need for DME.
  8. by   NRSKarenRN
    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.
  9. by   snotpikkr
    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.
  10. by   forbiggs
    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?
  11. by   snotpikkr
    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!
  12. by   MaritesaRN
    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........
  13. by   BFE/RN
    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