Sepsis / septic shock — fever/hypothermia with tachycardia, tachypnea, hypotension, or new confusion and a source — escalate/transfer on the sepsis pathway.

Rapid generalized deterioration — an acute, unexplained systemic decline — escalate for evaluation.

A constitutional change with an unstable vital-sign trend — escalate on the pattern (route to Vital Signs).

Goals-of-care inflection — a decline in a comfort-focused resident — confirm the advance directive and manage per goals.