How I Teach ICU Triage: A Three-Column Framework for Premorbid, Morbid, and Postmorbid Assessment

Abstract

Intensive care unit (ICU) triage is a cognitively complex and emotionally charged task that challenges clinicians across training levels. Although trainees may recognise prognostic factors and ethical principles, many lack a coherent structure to integrate these elements into a defensible real-time assessment. We describe a three-domain triage framework - Premorbid, Morbid, and Postmorbid - designed to support structured reasoning during ICU triage, particularly for on-call senior residents and clinicians who do not practice critical care routinely.

The framework is taught through case-based discussions embedded in routine clinical care within a high-volume medical ICU at a large tertiary hospital. The Premorbid domain considers baseline physiologic reserve, including functional status, prolonged hospitalization, nutritional state, and irreversible comorbidities. The Morbid domain focuses on the present illness, emphasizing etiologic diagnosis and recoverability, and the burden of ICU syndromes such as shock, respiratory failure, and acute kidney injury. The Postmorbid domain guides learners to translate these assessments into a set of realistic outcome trajectories, supporting clearer prognostication and communication.

By providing a shared language for discussions among senior residents, intensivists, and referring teams, the framework offers a practical cognitive scaffold for organizing complex information under pressure. Rather than eliminating uncertainty, the Premorbid–Morbid–Postmorbid framework provides trainees with a reproducible method to reason through uncertainty, communicate transparently and approach ICU triage with greater clarity and confidence.