Major GI bleeding — large-volume melena/hematochezia/hematemesis with tachycardia, hypotension, or syncope (especially on an anticoagulant) — escalate/transfer.

Bowel obstruction / acute abdomen — severe distension, rigidity, absent bowel sounds, persistent vomiting, or severe pain — escalate/transfer.

Stoma ischemia or retraction — a dusky/black or retracted stoma — notify the provider/surgeon urgently.

Severe dehydration from diarrhea — hypotension, tachycardia, oliguria, or new confusion — escalate; sepsis signs → transfer.