Harbor:Interqual Criteria Tips

For PEDIATRIC Interqual admission criteria, see below
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
  - Asthma:
    - Impending intubation OR NIPPV OR
    - Wheezing unresolved after meds AND cyanosis OR MS changes OR O2Sat <96% or PEF or FEV1 26-69% AND difficulty perceiving air flow obstruction or severity/hx of crit care admit/intubation/severe exac/systemic steroid use OR
    - O2sat <96%/PEF or FEV 26-39%/tachycardic/increased WOB AND medically complex
  - Bronchiolitis:
    - Impending intubation or NIPPV OR
    - O2sat <90% OR apnea OR cyanosis OR MS changes OR grunting/nasal flaring OR moderate to severe retractions OR
    - Age </= 2 mo and RR >70 OR Age > 2 mo and RR>60 AND
    - Respiratory monitoring every 4 hours OR O2 AND inadequate PO intake AND IVF
  - Constipation:
    - Failed outpatient laxative or enemas AND no BM for 7d AND colonic irrigation OR PEG solution
  - Dehydration/Gastroenteritis:
    - Age </= 1 yo and symptomatic/listless/lethargic/ labs with chloride <98 or >107 or bicarb </= 17 or K 2.5-3.2 or Na 146-158 AND oral rehydration, antiemetic, IVF, repletion of K
  - DKA:
    - Gluc >200 AND ketones+ AND anion gap>18 or pH <7.2 or serum HCO3 or CO2<10 AND continuous insulin drip AND IVF
  - Epilepsy:
    - Status epilepticus OR
    - New onset seizure >/2 sz w/in 24 hours continuous EEG w/in 24 hrs and anticonvulsants OR
    - Pregnant AND seizure/postictal OR
    - Known seizure d/o AND >/= 2 seizure w/in 24 hours and a change fom baseline OR
    - Progression in seizure type OR increase in seizure duration AND continuous EEG w/in 24 hours
  - FTT:
    - Suspected abuse/neglect OR
    - Severe malnutrition AND weight <70% of predicted weight for height or <60% for predicted weight for age OR
    - Moderate malnutrition/growth failure AND failed outpatient mgmt AND weight 70-80% predicted weight for height or 60-74% predicted weight for age, or failure to gain weight > 4 wks, or <3rd% for age/medically complex/transplant candidate/weight loss across 2 major percentiles w/in 6 months
  - Pneumonia:
    - Impending intubation OR NIPPV OR
    - Pneumonia by imaging AND hemodynamic instability OR
    - O2sat <90% OR
    - Age </=6mo and bacterial PNA OR empyema OR 2 or more lobes OR
    - Immunocompromised OR
    - Incr WOB (accessory muscle use, head bobbing, nasal flaring, retractions, etc.) OR
    - Dyspnea and hunched over positions, talks in words, unable to take PO OR
    - RR>/=60 (Age <3 mo) or RR>/=50 (age 3 to <18 mo) or RR>/=4- for 18 mo to <4 yo or RR>/=30 age 5 to 18yo OR
    - Lung abscess OR pleural effusion OR virulent pathogen OR Urine +legionella OR
    - Medically complex OR
    - Mental status change
  - Febrile seizure:
    - Only meets obs criteria, consider a different primary diagnosis
  - Sickle Cell Disease"
    - Acute pain requiring IVF AND IV analgesics >/=4x in 24 hrs
    - Acute chest syndrome AND anti-infective
    - Aplastic crisis requiring IVF OR transfusion and lab monitoring
    - Splenic sequestration AND IVF or transfusion
    - Fever >/= 38.5 AND anti-infective
  - Sepsis:
    - Impending intubation or NIPPV OR
    - Organ dysfunction OR
    - SIRS OR infection suspected and age 29d to < 3mo AND fever or hypothermia AND high risk hx (premature, congenital abnormality, toxic appearing, WBC</=5, or bands >/=15) OR
    - Infection suspected AND age >/= 3 mo AND diagnostic testing neg for source of infection AND 2 of the following
      - Temp elevated, HR elevated for age, mental status changes, neutropenia, O2sat >/= 93%, protracted vomiting, WBC elev or decr for age) AND
    - Age < 12 mo, anorexia, indwelling venous catheter, chronic ventilator, immunocompromised, malignancy requiring active treatment, medically complex

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