Triage Criteria for ADS Medicine and General Medicine
Updated 08/2023
1. Patients with the following should be considered for General Medicine Teaching:
Vitals after ED interventions:
- HR >125
- RR >30
- SpO2 <90% on 4L NC
- BP <90 or >200
Labs:
- lactate >4, not due to medications (e.g. albuterol)
- severe laboratory abnormalities requiring >q8 hour labs
- uptrending hs-trop of >5 ng/L with symptoms concerning for ACS and/or EKG changes
- AKI with new severe and/or symptomatic electrolyte derangements
General conditions:
- new AMS with concern for a new life-threatening condition[1]
- GI bleed with unstable vitals or a significant drop from baseline requiring repeat Hgb checks more often than Q8 hours.
- Patients with tracheostomy and/or PEG who require titration of vents or increased vent requirements, frequent suctioning and/or other active medical conditions which require closer monitoring.
- Moderate to severe alcohol withdrawal patients with concern for (A) delirium tremens, (B) withdrawal seizures, (C) unstable vital signs, or (D) CIWA >8 persisting despite benzodiazepine administration.
- appears “sick” or “in distress” requiring frequent monitoring
[1] Life-threatening AMS conditions may include lethargy requiring airway protection, meningitis, encephalitis, hypoglycemia, CVA, SAH, intracranial mass, seizures, herniation, hypertensive encephalopathy, Wernicke's encephalopathy, or life-threatening metabolic or endocrine abnormalities. If the degree of AMS is unclear in documentation, request bedside evaluation by MAPA for accurate triage.
2. Borderline Cases
● MAPA to see and examine borderline cases prior to triage
● Please email #Medicine Triage Group if you identify any cases where you feel triage was incorrect
3. Stepdown or RESUS Admissions
● In addition to the primary team, MAPA should page the overnight hospitalist at 7662 with any RESUS or Stepdown admissions to general medicine teaching
● The residents should discuss all RESUS and Stepdown admissions to teaching with the overnight hospitalist at p7662, as well with any other patients who require escalation of care
4. Admissions requiring ICU Evaluation
If you feel an admission meets criteria for ICU care, escalate to the night hospitalist at p7662. The night hospitalist will evaluate the patient and discuss obtaining ICU evaluation with the ED if not already done, or discuss triage with the ICU team if already seen by ICU.
Expanded Triage Criteria for ADS Medicine
The following criteria are to be used to assess critically ill patients who would not benefit from ICU-level care. If a patient meets the criteria below, they can be discussed with the lead hospitalist for triage to the High Acuity ADS Medicine service.
The case must satisfy both the Goals of Care Criteria and the Clinical Criteria listed below:
Goals of Care Criteria:
● If the patient, the healthcare proxy, or the next of kin have decided that their goals are consistent with hospice care (must meet the following):
○ A hospice bed is not yet available OR the patient is not a candidate for a hospice bed (e.g. is intubated and palliative extubation is not desired)
● If the patient, the healthcare proxy, or the next of kin have decided that their goals are NOT consistent with hospice care (must meet the following):
○ The patient has DNR/DNI status OR is DNR and has a secured airway (endotracheal tube or tracheostomy)
Clinical Criteria (must meet ALL of the following):
● The goals of care are clearly documented
● The patient is not expected to benefit from more than twice daily labs
● The patient is not expected to require more than two daily assessments by a physician (including discussions with family)