Any acute instability — respiratory distress, chest pain, a new focal neuro deficit, sepsis signs, major bleeding, or a suspected fracture — assess and escalate/transfer per the relevant clinical reference’s red flags.

Unrelieved or rapidly worsening change — escalate promptly rather than continuing to monitor; a change not communicated is a deficiency (F580).

Code-status and goals-of-care ambiguity during a decline — confirm the advance directive/POLST before escalation and document it.