Utilisation Review
Also written as: UR — Utilisation Review
The ongoing clinical and administrative process of evaluating whether a patient's continued inpatient psychiatric stay is medically necessary and supported by documented clinical criteria.
Full Definition
Utilisation Review (UR) is a formal process in which trained clinicians or UR nurses assess patient records to determine whether the intensity of care being delivered is medically necessary, clinically appropriate, and consistent with payer criteria such as InterQual or Milliman Care Guidelines. In psychiatric hospital settings, UR drives decisions about admission authorisation, concurrent review, and discharge timing. Editors preparing UR correspondence and denial letters must use precise, criterion-based language and ensure that clinical justifications align with the documented level of care. American English uses 'utilization'; British-influenced house styles may retain 'utilisation'—editors must apply the house standard consistently.
Usage
Usage note: Note the spelling variation: 'utilization' (US) vs 'utilisation' (UK/international). Apply the facility's house style consistently. 'UR' is acceptable after first use.
In Context
- "The utilisation review nurse contacted the insurer to obtain authorisation for an extended inpatient stay based on ongoing safety concerns." — Utilisation review log
- "UR documentation must clearly articulate why the patient's condition cannot be safely managed at a lower level of care." — Payer denial appeal letter