RN Tools
Number and Complexity*
a. May require admission/aggressive treatment & care escalation.b. Threat to life/body function w/out treatment.c. Chronic problem worse from baseline.d. Problem is at its baseline.e. New, serious (not minor) undiagnosed problem.f. Serious systemic symptoms in associated illness.g. Extensive injury or impacting multiple body systems, has multiple treatment options, or morbidity.h. ≥2 problems that are self-limited.i. Problem is at its baseline.j. Low risk of morbidity, little-to-no mortality risk.k. New/recent problem, but stable.l. Relatively minor problem, but still needing hospital care.m. Problem that is self-limited.
Risk level*
High: parenteral controlled substances, elective/emergency major surgery decision, hospitalized considered, or DNR/de-esc consideredModerate: prescription drug management, minor/major surgery decision, or limited by social DOHSee Evidence for details.
Tests ordered*
Unique item like a CBC, troponin, CT scan, EKG, etc.
Tests results reviewed (excluding labs)*
Review of imaging, EKGs, etc.
Prior external notes reviewed*
Outside ED/hospital setting or specialty
Assessment requiring and independent historian*
Independent historian: anyone who provides additional information patient can’t provide, does not include interpreters
Independent interpretation of tests*
Test interpreted by ER doctor but formal read will be done (and billed for) by another HCP
Discussed management/test interpretation w/external professional*
With external physician/other qualified health care professional/appropriate source, not separately reported
Problems: Low (3) <br/> Risk: Moderate (4) <br/> Data: Moderate (4)
4
Estimated Level of Service
Rates level of service required in emergency medicine.
Number and Complexity of Problems:
| Number and Complexity | Description |
|
a. High: ≥1 chronic illnesses with severe exacerbation, progression, or side effects of treatment b. High: 1 acute or chronic illness or injury that poses a threat to life or bodily function |
a. May require admission/aggressive treatment and care escalation b. Threat to life/body function without treatment |
|
c. Moderate: ≥1 chronic illnesses with exacerbation, progression, or side effects of treatment d: Moderate: 2 stable, chronic illnesses e. Moderate: 1 undiagnosed new problem with uncertain prognosis f. Moderate: 1 acute illness with systemic symptoms g. Moderate: 1 acute, complicated injury |
c. Chronic problem that is worse than baseline d. Chronic illnesses are at baseline e. New, serious undiagnosed problem f. Serious systemic symptoms associated with acute illness g. Extensive injury, impacting multiple body systems, higher risk of morbidity with multiple treatment options |
|
h. Low: ≥2 self-limited/ minor problems i. Low: 1 stable, chronic illness j. Low: ≥1 acute, uncomplicated illness or injury k. Low: 1 stable, acute illness l. Low: ≥1 acute, uncomplicated illness or injury requiring inpatient or obs care |
h. ≥2 self-limited problems i. Chronic illness at baseline j. Limited injury, low risk of morbidity, little to no mortality risk k. Newer illness or diagnosis that is stable l. Minor, new problem or injury that requires hospital care |
| m. Minimal: 1 self limited/minor problem | m. Problem or illness that is self limited |
Risk of Morbidity, Mortality, or Complications:
| Risk Level | Description |
| High |
• Drug therapy requiring intensive monitoring for toxicity • Decision regarding elective major surgery with identified patient or procedure risk factors • Decision regarding emergency major surgery • Decision regarding hospitalization or escalation of hospital-level care • Decision not to resuscitate or to de-escalate care because of poor prognosis • Parenteral controlled substances |
| Moderate |
• Prescription drug management • Decision regarding minor surgery with identified patient or procedure risk factors • Decision regarding elective major surgery without identified patient or procedure risk factors • Diagnosis or treatment significantly limited by social determinants of health |
| Low | - |
| Minimal | - |
Amount and/or Complexity of Data:
| Criteria | Category |
| - | Minimal |
|
Must meet at least 1 of 2 categories: Any combination of 2 from the following: • Ordering of each unique test • Review of the result(s) of each unique test • Review of prior external note(s) from unique source Category 2: Assessment requiring an independent historian |
Limited |
|
Must meet at least 1 of 3 categories: Any combination of 3 from the following: • Ordering of each unique test • Review of the result(s) of each unique test • Review of prior external note(s) from unique source • Assessment requiring an independent historian Category 2: Independent interpretation of testsCategory 3: Discussion of management or test interpretation w/ external professional |
Moderate |
|
Must meet at least 2 of 3 categories: Category 1: Tests, documents, or independent historian(s)Any combination of 3 from the following: • Ordering of each unique test • Review of the result(s) of each unique test • Review of prior external note(s) from unique source • Assessment requiring an independent historian Category 2: Independent interpretation of testsCategory 3: Discussion of management or test interpretation w/ external physician |
Extensive |
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