InterQual evidence-based clinical decision

The history of InterQual continues to be written, but what it has achieved in 30 years is remarkable. Thousands of people in hospitals, health plans and government agencies use InterQual evidence-based clinical decision support criteria daily to help answer critical questions about the appropriateness of levels of care and resource use.

The criteria have helped define and legitimize the disciplines of utilization and care management, giving medical directors and other hospital and health-plan professionals support in making the type of objective, evidence-based decisions that define top-quality, efficient care and open the door to greater transparency and collaboration between payors and providers. The Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) licenses InterQual Criteria for use in reviewing Medicare hospital inpatient services.

Guidelines for EKG– • One baseline EKG required at the first office visit {First try to get it from previous PCP} • Second EKG required according to pt’s symptoms, e. g. syncope, palpitations, chest pain, shortness of breath or as per MD’s clinical judgment Guidelines for Echocardiogram— • New onset of afibrillation/atrial flutter • New EKG abnormality { Always compare with old EKG} • Arrhythmias • New murmur by physical exam LV function assessment—h/o CABG, h/o CHF, New CHF by physical exam, acute MI, old MI, periodic assessment of EF < 40%, pt on chemo with cardio toxic agents • Before sending pt to Cardiology • Suspected valvular endocarditis • Prosthetic valve assessment • Valvular heart disease.