Train Wreck
A train wreck is a disaster patient that means 1 MAJOR and 2 MINOR criteria below[1]:
Major Criteria
- Sign out 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”
Minor Criteria
- 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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