Escalation must follow the patient's orders and agency policy; the following are representative thresholds.
🚩 Red flags — escalate
An acute change in mental status, new confusion, or a fluctuating level of consciousness — delirium: urgent evaluation for a medical cause, and activate emergency response (911) for a severely altered or declining level of consciousness.
A new focal neurologic sign with a cognitive change — possible stroke: activate emergency response (911) (detail in Neurological).
Cognitive impairment creating an imminent safety danger — wandering, leaving appliances on, or medication errors — an urgent safety plan (detail in Safety).
Behavioral or psychological symptoms posing a risk to the patient or others — urgent evaluation.
A capacity concern that affects safety or the ability to consent — prompt provider and care-team coordination.
Severe agitation with an acute change — urgent evaluation for a medical or psychiatric cause.
