Section 81.11. Inpatient hospitalization guidelines.

 

(1)   General principles.

(a) For purposes of this chapter, hospitalization is characterized as inpatient if the patient spends at least one night in a hospital, except for a patient in outpatient short stay status recovering after surgery for less than 24 hours or a patient in observation status.

(b) Unless a patient's condition requires special care, only ward or semiprivate accommodations are necessary. The admitting health care provider shall document the patient's special care needs.

(c) Admission before the day of surgery is necessary only if it is medically necessary to stabilize the patient before surgery. Admission before the day of surgery to perform any part of a preoperative work-up that could have been completed as an outpatient is not necessary.

(d) Inpatient hospitalization solely for physical therapy, bedrest, or administration of injectable drugs is necessary only if the treatment is otherwise necessary and the patient's condition makes the patient unable to perform the activities of daily life and participate in the patient's own treatment and self-care.

(e) Discharge from the hospital shall be at the earliest possible date consistent with proper health care.

(2)   Specific guidelines for hospital admission of patients with low back pain.

(a) A health care provider shall direct hospitalization for low back pain in the circumstances in pars. (b) to (e) .

(b) When the patient experiences incapacitating pain as evidenced by inability to mobilize for activities of daily living, for example unable to ambulate to the bathroom, and, in addition, the intensity of service during admission meets any of the following:

1. Physical therapy is necessary at least twice daily for assistance with mobility. Heat, cold, ultrasound, and massage therapy alone do not meet this criterion.

2. Muscle relaxants or narcotic analgesics are necessary intramuscularly or intravenously for a minimum of 3 injections in 24 hours. Need for parenteral analgesics is determined by any of the following:

a. An inability to take oral medications or diet by mouth.

b. An inability to achieve relief with aggressive oral analgesics.

(c) For surgery that is otherwise necessary according to s. DWD 81.12 (1) and is appropriately scheduled as an inpatient procedure.

(d) For evaluation and treatment of cauda equina syndrome according to s. DWD 81.06 (13) .

(e) For evaluation and treatment of foot drop or progressive neurologic deficit according to s. DWD 81.06 (13) .

CR 07-019 : cr. Register October 2007 No. 622 , eff. 11-1-07.