What justifies a Second Midnight stay?
Is the patient stable after the initial midnight or do they require further hospitalization? Why?
-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?
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.