Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Admission Criteria Clinical Practice Policy

Transcription

1 Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Admission Criteria Clinical Practice Policy Original Date: 04/2011 Purpose: To specify physiologic criteria for appropriate patient Supersedes: 04/2011 triage to admission level of care. Last Review Date: 09/2017 See below for Floor, SIMU, and STICU admission criteria. 1

2 6 Jones Adult Admission Criteria Appropriate for Floor Admission Oxygen Requirement NVS Q4-12HRS Vital sign > IV electrolyte replacement VS/Assessments > Q 5L/min nasal cannula Trach collar 40% <40% facemask O2 Resp/Nebulizer treatments > Q Q Anticoagulant or antiplatelet IV infusions I/O Q 1/2:1 Fluid Replacement FBG/SQ insulin Q4-12HRS Continuous Bladder Irrigation I&O Cath Q Lab draws Q IV Med administration >Q Free Flap Protocol CPAP (pt history of OSA) IS within expected volume Suction > 4 HRS Inappropriate for Floor Admission >5L Nasal Cannula Trach collar > 40% <Q4H RT treatments NVS <Q Continuous IV drip sedation or analgesics Vital sign < Invasive hemodynamic Titratable vasoactive drips CPR within 2 I/O <Q Uncontrolled FBG requiring SIMU/STICU sliding scale Nursing interventions <Q 2

3 8 Jones Adult Admission Criteria Appropriate for Floor Admission Oxygen Requirement NVS Q4-12HRS Vital sign > IV electrolyte replacement VS/Assessments > Q 5L/min nasal cannula Trach collar 40% <40% facemask O2 Resp/Nebulizer treatments > Q Q Anticoagulant or antiplatelet IV infusions I/O Q 1/2:1 Fluid Replacement FBG/SQ insulin Q4-12HRS Continuous Bladder Irrigation I&O Cath Q6HRS Lab draws Q IV Med administration >Q Free Flap Protocol CPAP (pt history of OSA) IS within expected volume Suction > 4 HRS Inappropriate for Floor Admission >5L Nasal Cannula Trach collar > 40% <Q4H RT treatments NVS <Q Continuous IV drip sedation or analgesics Vital sign < Invasive hemodynamic Titratable vasoactive drips CPR within 2 I/O <Q Uncontrolled FBG requiring SIMU/STICU sliding scale Nursing interventions <Q 3

4 SIMU Admission Criteria Appropriate for SIMU Admission Continuous pulse oximetry (airway edema, new post-op trachs, extubation within last 2) 5L/min nasal cannula Trach collar >30% and 60% 40% facemask O2 Resp/Nebulizer treatments Q2-3HRS BIPAP up to 100% (Reassess in 4 for PAO2 >88%, consider transfer if no improvement) IS or vital capacity below expected volume Vapotherm FiO2 <60% (Reassess in 4 for PAO2 >88%, consider transfer if no improvement) NVS Q2- (head injury, seizures or unstable spine) Lumbar drain Q2- Continuous cardiac and hemodynamically stable Vital sign Q2- CVP or arterial line Q2- Amiodarone drip per protocol Cardizem drip per protocol Post-op TEVAR and hemodynamically stable Anticoagulant IV infusions Continuous Lasix infusion Continuous IV electrolyte replacement I/O Q2-1:1 Fluid Replacement Titratable insulin drips/q4hr SQ insulin per SIMU protocol VS/Assessments Q2- I&O Cath Q Lab draws Q2- IV Med administration Q2- Dressing changes >30 minutes every 8 Bronchoscopy in patients with tracheostomy Ketamine drip via PCA Lidocaine drip for pain management Inappropriate for SIMU Admission Trach collar 60% >Q2H RT treatments NVS >Q2HRS Continuous IV drip sedation or analgesics Vital sign >2HRS Continuous Invasive hemodynamic Titratable vasoactive drips CPR within 2 I/O >Q2HRS Uncontrolled FBG requiring STICU sliding scale *OK for bedside procedures if Attending at bedside and ICU nurse available to administer sedation and recover patient Nursing interventions required less than every 2 Bedside procedures requiring intensive airway (bronchoscopy without tracheostomy, EGD) Administration of conscious sedation** Serial bladder pressure 4

5 STICU Admission Criteria Pt demonstrating respiratory deterioration with dyspnea or/and falling O2 Stats Increased respiratory rate with retractions or accessory ventilatory muscle use Copious secretions requiring suctioning >Q2 Nebulizer/MDI treatments < q 2 Trach collar requiring >60% O2 BiPap requiring >60% O2 without improving respiratory status Mechanical ventilation Q 1 hour neuro checks GCS<10 and or falling Unstable C-Spine or T- Spine analgesia or sedation agents neuromuscular blocking agents anticonvulsant agents Intracranial pressure or drain required EXCLUSIONS FOR STICU (See SIMU & Floor Admission Criteria) <5L Nasal Cannula Neuro checks >q2 Trach collar <60% O2 >Q2 RT treatments C-spine or T-spine IS within expected stable volume Adequate pain control No evidence of respiratory distress Continuous cardiac Continuous invasive homodynamic Post-op or inpatient hemodynamically unstable as evidenced by HR <55 or >120, MAP<49, UOP<30 ml/hr, Hbg decreasing >1 gm every 4 vasoactive agents anti arrhythmia agents requiring active titration CPR within last 24 ECMO Vital sign Q2-3 Hemodynamically stable Q1 hour I/O Electrolyte imbalances requiring IV electrolyte replacement secondary to arrhythmia Uncontrolled FBG requiring titrating insulin gtt according to STICU Insulin Protocol Acute Renal Failure (decreased urine output, increased BUN and Creatinine CVVHD I/O <2 FBG controlled with SIMU or Floor Insulin sliding scale Extensive or complex dressing changes >1 hour per shift Multiple nursing interventions > q 2 Lab draws >Q2 Serial bladder pressures Nursing interventions < 2 Lab draws < 2 Dressing changes >1 hour per shift 5