Harbor:Interqual Criteria Tips

Interqual 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
  - Migraine
  - Nephrolithiasis
  - Hypoglycemia
  - Pneumonia
  - PE
  - Pyelonephritis
  - Sickle Cell
  - Stroke
  - Syncope
  - TIA

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