Table 1.

IMCU Guidelines

Category	IMC Admission Guidelines	Trigger for ICU Consult/Transfer
Monitoring/General	Q2h vital signs or less frequent Labs Q2h (Q1h glucose) or less frequent Continuous pulse oximetry & cardiac monitor Arterial/venous pressure	Q1h vitals needed for > 4h (one 4h interval of Q1h vitals within 24h acceptable)
Respiratory	PaO2 ≥ 60 mmHg or SpO2 ≥ 90% Suctioning Q2h or less frequently Nebulizer treatment q2h or less frequently NC, Hi-Flow NC, FM O2 BIPAP/CPAP (new or chronic) Patient > 24h from tracheostomy Prostacyclin infusion for pulmonary hypertension	FiO2 1.0 for > 24h Respiratory rate > 35, accessory muscle use Suctioning Q1h or more often > 8h Continuous nebulizer treatment
CV – HTN	Hypertensive urgency Intravenous push anti-hypertensive Labetalol, nicardipine, nitroglycerine infusion	Hypertensive emergency Frequent titration of infusions (more often than Q2h)
CV – CHF, MI, Sepsis	Hemodynamically Stable NSTEMI Dopamine ≤ 10 mcg/kg/min (≤3 titrations/day) Dobutamine ≤ 10 mcg/kg/min (≤3 titrations/day)	STEMI Shock* Vasopressor for sepsis
CV – Arrhythmia	Risk of life threatening arrhythmia IVP adenosine, diltiazem, labetalol, metoprolol Diltiazem, labetalol, & amiodarone infusion	Need for temporary pacer (TC or TV) Bedside cardioversion Frequent titration of infusions (more often than Q2h)
Gastrointestinal	GI bleeding with orthostasis but not shock ≤ 10 point drop from baseline hematocrit Acute liver failure Hepatic encephalopathy ≤ grade III S/P uncomplicated TIPSS	GI bleeding with shock/need for venous sheath (Cordis) > 10 point drop from baseline hematocrit Grade IV encephalopathy, hepatic coma
Renal	Bedside intermittent hemodialysis Acute hemodialysis for drug intoxication Electrolyte abnormalities at risk for arrhythmias Electrolyte abnormalities requiring frequent labs	Hemodynamic intolerance of IHD
Metabolic	Metabolic disorders requiring frequent labs (i.e., DKA, non-ketotic hyperglycemia)
Hematologic	Thrombolytic infusion (no bolus) for stable patients	Bolus or infusion of thrombolytics for unstable patients (i.e. submassive PE)
Neurological	Neuro checks Q2h or less frequently High aspiration risk due to impaired mental status Alcohol WD (benzodiazepine infusions permitted) Opiate overdose (naloxone infusion permitted) PCA and epidural PCA pumps	Sustained Glasgow Coma Score < 9 Neuro checks more often than Q2h for > 8h Uncontrolled alcohol WD & frequent titration of benzodiazepine infusion
Miscellaneous	Endoscopy without sedation Venous sheaths permitted (non-hemorrhage patients) Arterial sheaths permitted × 4h	1:1 nursing care > 4h
Prohibited	Temporary pacing, PA catheters, lumbar drains, intrapleural bupivacaine, bladder pressure Non-emergent cardioversion, continuous nebulizer treatments, intermittent hemodialysis on vasopressors, continuous renal replacement therapy, procedural sedation

CHF: Congestive Heart Failure

CV: Cardiovascular

DKA: Diabetic Ketoacidosis

GI: Gastrointestinal

IHD: Intermittent Hemodialysis

HTN: Hypertension

MAP: Mean Arterial Pressure

MI: Myocardial Infarction

NC: Nasal Cannula

NSTEMI: Non-ST-Elevation MI

PA: Pulmonary Artery

PCA: Patient Controlled Analgesia

PE: Pulmonary Embolus

Q#h: Every # hours

SBP: Systolic Blood Pressure

TC: Transcutaneous

TIPSS: Transhepatic intravenous porto-systemic shunt

TV: Transvenous

WD: Withdrawal

^*Shock: SBP < 90 mm Hg or MAP < 60 mm Hg with end organ dysfunction