TKA Second Midnight Questionnaire

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What justifies a Second Midnight stay?

Is the patient stable after the initial midnight or do they require further hospitalization? Why?

-Intractable pain
-Inability to tolerate PO / refractory vomiting
-Inability to ambulate safely

Is there new clinical information gathered in the first 24 hours that justifies further workup?

Is the patient receiving hospital level of care/inpatient services?
-IV drips (Heparin, Insulin, NTG)
-1:1 sitter / restraints
-Urgent / emergent surgery

Can the same care be administered in the outpatient setting?

-What are the risks involved if the workup IS pursued outside the hospital?

Are all of the above points clearly and appropriately documented?

-Document explicitly

Does the documentation validate a second midnight?

-Justifies admission and continued hospitalization
-Supports the primary diagnosis
-Describes the patient’s progress and response to medications and services

Is this care reasonable and necessary?

Download the complete tip, TKA Second Midnight Questionnaire.