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Difficulty: EasyDisposition and Care Setting Transitions

Match each patient's clinical presentation and calculated risk stratification score to the most appropriate initial disposition setting.

  • 45-year-old patient with community-acquired pneumonia, stable vital signs, and a CURB-65 score of 0Discharge home with oral antibiotics and outpatient follow-up
  • 75-year-old patient with community-acquired pneumonia, respiratory rate of 34/min, blood pressure 85/50 mmHg, and a CURB-65 score of 4Admission to the Intensive Care Unit (ICU)
  • 68-year-old patient with community-acquired pneumonia, blood urea nitrogen (BUN) of 26 mg/dL, and a CURB-65 score of 2Admission to a general medical ward for close observation and intravenous therapy
  • 50-year-old patient with atypical chest pain, normal serial electrocardiograms, negative troponins, and a HEART score of 1Discharge home with early outpatient cardiology follow-up

Answer

Low-risk scores (CURB-65 of 0, HEART of 1) match with home discharge; the moderate-risk score (CURB-65 of 2) matches with general medical ward admission; and the high-risk score (CURB-65 of 4) matches with Intensive Care Unit admission.
The correct pairings directly apply established clinical guidelines. The CURB-65 score groups pneumonia mortality risk into low (0-1, outpatient), moderate (2, inpatient ward), and high (3-5, ICU admission). The HEART score categorizes chest pain patients into low risk (0-3, safe for discharge), moderate risk (4-6, observation/admission), and high risk (7-10, urgent intervention).

Step-by-Step Solution

1
Evaluate the specific risk stratification score provided for each patient scenario.
Identified low-risk (CURB-65: 0, HEART: 1), moderate-risk (CURB-65: 2), and high-risk (CURB-65: 4) patients.
Objective scoring systems are the first step in evidence-based disposition planning.
2
Correlate each risk tier with the appropriate intensity of care.
Low-risk patients do not require hospitalization. Moderate-risk patients require floor admission. High-risk patients require critical care.
Disposition must match the patient's predicted clinical trajectory and need for intensive monitoring or interventions.
3
Match the required level of care to the specific disposition setting options provided.
Paired the settings appropriately without over-triaging or under-triaging the patients.
Ensures patient safety while optimizing hospital resource utilization.

Key Concept

Application of validated clinical risk stratification scores (e.g., CURB-65, HEART) to guide safe and resource-appropriate patient disposition.
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Topics

Disposition and Care Setting Transitions

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