Trauma/SICU Fever Workup Guideline (Draft)

Status: Draft for committee approval
Purpose: Reduce unnecessary pan-culture behavior while preserving patient safety.

Trigger Principles

1. One isolated fever does not automatically require full pan-culture.
2. Use clinical context, trend, and source likelihood before ordering tests.
3. If already on broad-spectrum coverage, test only if results will change management.

Suggested Workflow

1. Confirm fever and timing trend.
2. Perform focused clinical exam and source review.
3. Order targeted diagnostics only when they are expected to alter treatment.
4. For urinary testing:

• Require urinary source suspicion.
• If chronic Foley and culture indicated, replace catheter before culture.
• Do not send UA/culture for cloudy/foul-smelling urine alone.

Urinary Testing Hard Stops

Do not order UA/culture based only on:

• cloudy urine,
• odor,
• urine color/sediment, or
• pyuria without compatible clinical syndrome.

Documentation Standard

1. Document why each test is ordered.
2. Document what management decision the result will influence.
3. Document why potential alternative sources were accepted or excluded.

Escalation Criteria

Escalate to attending/APP immediately if:

• Hemodynamic instability.
• Rapid oxygenation decline.
• New focal signs suggesting uncontrolled source.
• Persistent fever pattern with worsening inflammatory markers.

Committee Approval Items

1. Final trigger definition for one-fever vs persistent-fever pathway.
2. Required provider sign-off conditions.
3. Resident education rollout date.