Diagnostic Criteria for a “Train Wreck” Patient

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"Look away if you have a weak stomach..."
Look away if you have a weak stomach…

How does one identify a train wreck?  GomerBlog polled 1,000,000 health care providers in the last 48 hours and the general consensus is that, of the following, 1 MAJOR plus 2 MINOR criteria are sufficient to make the diagnosis of train wreck:

Signout from a colleague on the patient takes more than 5 minutes
– At least 6 consultants on board, one of which is Infectious Diseases or Palliative Care
– Someone utters “I have no clue what’s going on”
– Someone utters that the patient is a “train wreck”

– 75% of vital signs and lab results in red (or abnormal) font
– Dyad of coded and Full Code
– Triad of renal failure, atrial fibrillation requiring a drip, and anemia requiring a transfusion
– At least 5 organ systems affected, with at least one still worsening
– At least 5 hospital days spent in the ICU
– At least 3 foreign bodies in place (Foley, central line, NG tube, PICC, drain, etc.)
– At least 2 active infections, one of which is MRSA or C. diff
Another service should really be the primary team, but are not
– Patient without decision-making capacity AND family nowhere to be found
– Patient’s length of stay > 15 days OR his/her age
– Social Services has given up on a post-hospital plan of care

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