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
Authors: