| LEVEL OF RISK |
PRESENTING PROBLEM(S) |
DIAGNOSTIC PROCEDURE(S) ORDERED |
MANAGEMENT OPTIONS SELECTED |
Minimal Risk
(Level 2) (Requires only ONE element from ANY of the 3 categories) |
- One self-limited or minor problem (e.g., cold, insect bite, tinea corporis)
|
- Laboratory tests requiring venipuncture
- Chest x-rays
- EKG/EEG
- Urinalysis
- Ultrasound (e.g., echocardiography)
- KOH prep
|
- Rest
- Gargles
- Elastic bandages
- Superficial dressings
|
| Low Risk (Level 3)
(Requires only ONE element from ANY of the 3 categories) |
- Two or more self-limited or minor problems
- One stable chronic illness
- (e.g., well-controlled hypertension, non-insulin dependent diabetes, cataract, BPH)
- Acute uncomplicated illness or injury (e.g., cystitis, allergic rhinitis, simple sprain)
|
- Physiologic tests not under stress (e.g., pulmonary function tests)
- Non-cardiovascular imaging studies with contrast (e.g., barium enema)
- Superficial needle biopsies
- Clinical laboratory tests requiring arterial puncture
- Skin biopsies
|
- Over-the-counter drugs
- Minor surgery with no identified risk factors
- Physical therapy
- Occupational therapy
- IV fluids without additives
|
Moderate Risk
(Level 4) (Requires only ONE element from ANY of the 3 categories) |
- One or more chronic illnesses with mild exacerbation, progression, or side effects of treatment
- Two or more stable chronic illnesses
- Undiagnosed new problem with uncertain prognosis (e.g., lump in breast)
- Acute illness with systemic symptoms (e.g., pyelonephritis, pneumonitis, colitis)
- Acute complicated injury (e.g., head injury with brief loss of consciousness)
|
- Physiologic tests under stress (e.g., cardiac stress test, fetal contraction stress test)
- Diagnostic endoscopies with no identified risk factors
- Deep needle or incisional biopsy
- Cardiovascular imaging studies with contrast and no identified risk factors (e.g., arteriogram, cardiac catheterization)
- Obtain fluid from body cavity (e.g., lumbar puncture, thoracentesis, culdocentesis)
|
- Minor surgery with identified risk factors
- Elective major surgery (open, percutaneous or endoscopic) with no identified risk factors
- Prescription drug management¶
- Therapeutic nuclear medicine
- IV fluids with additives
- Closed treatment of fracture or dislocation without manipulation
|
| High Risk (Level 5)
(Requires only ONE element from ANY of the 3 categories) |
- One or more chronic illnesses with severe exacerbation, progression, or side effects of treatment
- Acute or chronic illnesses or injuries that pose a threat to life or bodily function (e.g., multiple trauma, acute MI, pulmonary embolus, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatric illness with potential threat to self or others, peritonitis, acute
- renal failure)
- An abrupt change in neurologic status (e.g., seizure, TIA, weakness, sensory loss)
|
- Cardiovascular imaging studies with contrast with identified risk factors
- Cardiac electrophysiological tests
- Diagnostic Endoscopies with identified risk factors
- Discography
|
- Elective major surgery (open, percutaneous or endoscopic) with identified risk factors
- Emergency major surgery (open, percutaneous or endoscopic)
- Parenteral controlled substances
- Drug therapy requiring intensive monitoring for toxicity
- Decision not to resuscitate or to de-escalate care because of poor prognosis
|
