Train Wreck

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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

Related Topics

- Batsh*t Crazy

- Fibro Storm

- Hot Mess

- Temper Tantrum


  1. Diagnostic Criteria for a “Train Wreck” Patient

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