Scout was developed to help hospital providers determine a patient's status by establishing medical necessity through documentation. The status affects many aspects of the patients care such as available resources at discharge, the cost to the patient and placement opportunities.
"The physician or other practitioner responsible for a patient's care at the hospital is also responsible for deciding whether the patient should be admitted as an inpatient. Physicians should use the expectation of the patient to require hospital care that spans at least two midnights period as a benchmark, i.e., they should order admission for patients who are expected to require a hospital stay that crosses two midnights and the medical record supports that reasonable expectation."
Medicare Benefit Policy Manual, Publ. 100-2, Ch. 1, § 10,
The patient status, while the responsibility of the provider, is ultimately approved or denied at the discretion of the insurance company/CMS based on their opinion of 'reasonable expectation' of care. This often times leaves both the provider and the patient frustrated as the provider is unaware of the nebulous criteria that determine the patient's status regardless of the fact that the order is supposed to be based on the providers best judgment.
Scout criteria were compiled specifically for medical and surgical conditions frequently seen in the hospital. The criteria are based on the diagnosis-related group (DRG) information, major comorbid conditions, and comorbid conditions. Then they were expanded upon through identifying the conditions standard of care and indications for treatment. This was aided by physician medical experience and utilization management review experience.
Clinical Documentation Improvement
Clinical documentation improvement recommendations were cross-referenced with scout criteria. Many of the different measurements of the patient's severity of illness depend on the provider's accuracy of documentation. By linking Scout criteria and CDI recommendations, the provider can optimize their documentation to accurately reflect the patient's clinical condition.
Telemetry guidelines were added to assist in the decrease of telemetry overuse. Providers typically place a patient on telemetry by gut feeling. This leads to an increasing number of patients inappropriately on telemetry and subsequently a shortage of available units and beds. Patients will then be boarded in the emergency room while telemetry units are urgently 'freed up'.
Telemetry guidelines links are placed on every Scout criteria diagnosis to ensure ease of reference to the provider when reviewing the admit order.
The goal is to have the patient in the right status and location from the start.