Wiki Escalation of hospital level of care

[Bernadette10]

Can someone tell me what kinds of things are considered escalation of hospital level of care? I haven't been able to find a good reference for this. I know transferring to ICU or CCU and urgent dialysis are examples. What about ordering a consult by another specialist, increasing the amount of oxygen, adding another medication (vancomycin, doesn't specify whether IV or oral, no mention of labs for monitoring of toxicity)?

 

[Bernadette10]

I found this. Does anyone agree with this, that transferring to a nursing facility is escalation of hospital level of care? What about transferring to an acute recovery unit or SNF?

2023-MDM-Simplified.pdf
High risk of morbidity includes revised examples for 2023 which comprise of the decision regarding escalation of hospital-level care, like moving to a nursing facility, and parenteral controlled substances.

 

[csperoni]

I would not consider ordering a consult by another specialist, increasing the oxygen, or adding a medication as "escalation of hospital level of care."
Regarding transferring to a nursing facility, acute recovery unit or SNF. If the patient was prior in a higher level of care, I would not consider that escalation.
Parenteral controlled substances are not an escalation of hospital level of care, but would be considered a separate example of high level risk.
Example 1: patient is transferring from ICU to SNF - it's a change of hospital level, but I would not consider an escalation of hospital level.
Example 2: patient is currently in SNF and transferring to an acute recovery unit is likely an escalation. This would need to be supported by the records.