Typical Patients Admitted to Medical-Surgical Units
Medical-surgical units primarily admit patients with acute but stable conditions requiring frequent monitoring and multidisciplinary intervention, but who do not need intensive care-level support such as mechanical ventilation or vasopressor therapy.
Core Patient Categories
Postoperative Surgical Patients
Medical-surgical units commonly admit patients following surgical procedures who have achieved hemodynamic and respiratory stability 1:
- Cardiovascular surgery patients who are extubated with stable vital signs for 6-12 hours 1
- Thoracic and abdominal surgery patients without ongoing hemodynamic instability 1
- Neurosurgical patients post-procedure with stable neurological status 1
- Trauma patients (thoracic or abdominal) who are stabilized 1
- Patients requiring minimal oxygen (FiO2 ≤0.4) with acceptable gas exchange for at least 4 hours post-extubation 1
Metabolic and Endocrine Disorders
Patients with moderate metabolic derangements requiring continuous monitoring 1, 2:
- Moderate diabetic ketoacidosis (glucose >500 mg/dL or pH >7.2) on continuous insulin infusion without altered mental status 1
- Electrolyte abnormalities including hypokalemia (K+ 2.0-3.5 mEq/L), hyperkalemia (K+ 6.0 mEq/L), or symptomatic sodium disturbances 1, 2
- Hypoglycemia or hyperglycemia requiring frequent monitoring and intervention 1
Critical caveat: Severe hypokalemia (K+ <2.0 mEq/L) or patients with ECG changes should be admitted to telemetry or ICU, not standard medical-surgical units 2.
Gastrointestinal Conditions
Patients with GI pathology requiring frequent assessment 1:
- Acute GI bleeding without hemodynamic or respiratory instability 1
- GI foreign bodies requiring emergency endoscopy but without cardiorespiratory compromise 1
- Chronic GI conditions requiring multidisciplinary management 1
Renal Disease Patients
Patients with kidney dysfunction needing close monitoring 1:
- Hypertension requiring frequent IV or oral medication without seizures or encephalopathy 1
- Uncomplicated nephrotic syndrome with chronic hypertension 1
- Renal failure of any cause requiring monitoring 1
- Chronic dialysis patients (hemodialysis or peritoneal dialysis) 1
Respiratory Conditions
Patients with pulmonary issues who are stable enough to avoid ICU 1:
- Moderate respiratory compromise requiring supplemental oxygen but not mechanical ventilation 1
- Post-extubation patients with stable gas exchange 1
- Chronic obstructive pulmonary disease patients requiring monitoring but not intubation 3, 4
Important consideration: COPD patients undergoing surgery have significantly higher complication rates (29% overall, 60% for cardiac surgery) and should be monitored closely 3.
Key Admission Criteria
Medical-surgical units are appropriate when patients meet ALL of the following 1:
- Stable hemodynamic parameters for at least 6-12 hours 1
- No requirement for mechanical ventilation or only minimal oxygen support (FiO2 ≤0.4) 1
- Need for frequent monitoring but not continuous 1:1 or 1:2 nursing ratios 1
- Multiple disciplinary intervention required but not ICU-level organ support 1
Patients Who Should NOT Be on Medical-Surgical Units
These patients require higher levels of care 1:
- Multiple organ failure (≥2 failing organ systems) requiring device-based support 1
- Hemodynamic instability requiring vasopressors or inotropes 1
- Respiratory failure requiring mechanical ventilation or high-flow oxygen 1
- Severe metabolic acidosis requiring bicarbonate infusion with altered mental status 1