Harbor:Interqual Criteria Tips

• ADULT Interqual admission criteria
  • See helpful document File:InterQual admission guide checklist adult2021.pdf
  • Admitting for WORK-UP will never meet (be creative, talk to UR, and find an actual admission diagnosis)
  • Ever wonder why you need an override note? Here are some top diagnoses and what makes them meet for admission
    • We don't have obs status, which is why override notes are needed
    • Abdominal pain - will not meet (only obs)
    • Chest Pain - STEMI, NSTEMI, or suspected ACS with
      • new LBBB,
      • unstable angina and IV NTG, or
      • 2 or more doses of morphine
    • Anaphylaxis - inhaler Q2 hours, impending intubation or on BiPAP
    • Anemia - only for symptomatic hemolytic anemia with Hgb <10 AND
      • Hgb q12 hrs with transfusion or
      • steroids, immunotherapy, or immunoglobin
    • A-fib/flutter: Requiring continuous antiarrhythmic/digoxin loading/permanent pacemaker OR
    • Asthma: Impending respiratory failure, mechanical ventilation, NIPPV, status asthmaticus, PEF/FEV1 < 40% after 2h treatment in ED, PEF/FEV1 ≤ 25%, use of accessory muscles, MS changes/drowsiness, albuterol q1-2h continuous
    • Cellulitis: Immunocompromised OR located over a prosthesis/implanted device OR orbital
    • COPD exacerbation:
      • Impending intubation OR NIPPV OR mechanical ventilation OR dyspnea AND
      • ≥ 2 doses albuterol AND
      • Hypoxia or signif abnl blood gas: 02 sat ≤ 89% OR PaO2 ≤ 55 mmHg and pH > 7.45 OR Pco2 > 45 mmHg and pH < 7.35 OR

• • • • Increased work of breathing OR cyanosis OR risk factor (e.g., cor pulmonale, cancer, pneumonia, DM, home O2, Class III or IV HF, mental illness, substance use disorder, stable angina)
    • DVT: continuous unfractionated heparin AND risk of limb compromise and anticoagulation OR hospital acquired and initiation of anticoagulation OR IVC filter placement planned
    • DKA: BS > 250 mg/dL AND ketones elevated AND anion gap >12 mEq/L OR pH <7.25 serum OR HCO3 or CO2 < 15 mEq/L
    • Gastroenteritis/Dehydration: only meets obs criteria, consider another primary diagnosis
    • GI Bleed:
      • 1L IVF or blood product transfusion prior to decision to admit AND
      • Hct < 21%/Hb < 7 g/dL OR
      • Exertional dyspnea OR MS changes OR
      • INR ≥ 2 OR orthostatic hypotension OR presyncope/syncope
    • Heart Failure:
      • New onset symptoms AND rales, gallop, OR pleural effusion/pulmonary edema/cardiomegaly on CXR, OR edema, hepatomegaly, JVD OR BNP or NT-pro-BNP > ULN OR
      • Acute on chronic AND O2 sat < 89% after ≥ 1 diuretic dose and ≥ 2h treatment AND
      • Inadequate diuresis, troponin > ULN, Cr > 1.5x baseline, CKD (excludes dialysis) and Cr ≥ 2.75 mg/dL OR HR 100-120/min OR SBP ≤ 120 mmHg OR Na < 130 mEQ/L OR BUN > 43 mg/dL OR mental illness/cognitive impairment/substance use disorder OR
      • Dyspnea not returned to baseline after 1 dose of diuretic and ≥ 2h treatment
    • HTN:
      • End organ damage AND
      • hematuria OR proteinuria OR aortic aneurysm/dissection OR CHF OR encephalopathy/MS change OR papilledema/retinal hemorrhage/vision changes OR seizure
      • Pregnancy with HELLP OR preeclampsia OR SBP >/= 160, DBP >/= 110 after anti HTN med
    • Migraine:
      • only meets obs criteria, consider another primary diagnosis
    • Nephrolithiasis:
      • Obstruction by imaging AND nephrostomy planned OR
      • Urinary catheterization necessary and Cr >1.8
    • Hypoglycemia:
      • Gluc < 70 AND AMS OR Seizure
    • Pneumonia:
      • Impending intubation/vent dependent OR NIPPV OR
      • Pressors OR
      • O2Sat < 89% OR PaO2 < 56 OR PCO2 >/= 45 and pH >/= 7.31 OR
      • Empyema, or lung abscess or necrotizing
      • 2 or more lobes OR
      • Pneumonia severity index >/= 91 OR 3 or more CURB 65 criteria OR
    • PE:
      • Impending intubation/vent dependent OR NIPPV OR
      • PE by imaging AND anticaog AND hypoxia </= 90%, and requiring supplmental O2 OR
      • HIT OR HF requiring IV diuresis or titration of oral diuretic OR bridging AC OR IVC filter placement OR Continuous UFH OR
      • abnormal biomarkers OR RV dysfxn OR pressors OR lytics
    • Pyelonephritis/UTI: SIRS AND UCx pending AND
      • Urinary symptoms AND abnormal UA AND systemic infection or end organ compromise (+BCx, or >/= 24 weeks pregnant, or urinary stent/UTI obstruction, or organ dysfunction or hypoperfusion) A
    • Sickle Cell
      • Acute pain requiring IVF and IV analgesics >/=4x OR
      • Acute chest syndrome and anti-infective OR
      • Aplastic crisis requiring IVF OR transfusion and lab monitoring
      • Fever >/= 38.5 AND anti-infective
    • Stroke
      • Acute ischemic OR hemorrhagic stroke
    • Syncope
      • only meets obs criteria, consider another primary diagnosis (arrythmia, anemia, GIB, etc.)
    • TIA
      • Neuro deficit resolved/resolving AND crescendo TIA OR endocardial vegetation OR previous stroke

• PEDIATRIC Interqual admission criteria
  • See helpful document File:interqual_admission_guide_checklist_pediatrics2021.pdf