Any event in which patient safety is compromised 

Any time in which the resident feels uncomfortable or has a concern

Violation of mutual respect or disagreement with plan of care (patient, family or consultants)

Significant new vital sign abnormalities (systolic blood pressure <80 mmHg, heart rate >130 or <45 with concern for arrhythmia, new oxygen requirement of 4L or tachypnea)

Significant new laboratory abnormalities (K >6 mEq/L, Na <120 mEq/L, Hemoglobin drop requiring transfusion, lactate >4 mmol/L)

Change in mental status/new neurologic deficit or seizure/delirium tremens

Positive cardiac enzymes or significant EKG changes

Fall with injury

Suicide attempt/disruptive behavior

Procedures requiring consent (e.g. blood transfusion, paracentesis, central line)

Transfer to higher level of care (Step-down or ICU)

Unexpected death 

Against medical advice discharges or elopement