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How I Teach ICU Triage: A Three-Column Framework for Premorbid, Morbid, and Postmorbid Assessment
1Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
ATS Scholar
|August 8, 2026
Summary
A new three-domain framework (Premorbid, Morbid, Postmorbid) aids clinicians in structured intensive care unit (ICU) triage. This approach enhances reasoning, communication, and confidence when managing complex patient cases under pressure.
Area of Science:
- Medical Education
- Critical Care Medicine
- Clinical Decision-Making
Background:
- Intensive care unit (ICU) triage is a complex cognitive and emotional task for clinicians.
- Trainees often struggle to integrate prognostic factors and ethical principles into real-time triage assessments.
- A structured approach is needed to support clinicians, especially those less experienced in critical care.
Purpose of the Study:
- To introduce and describe a three-domain triage framework (Premorbid, Morbid, Postmorbid) for ICU triage.
- To provide a structured cognitive scaffold for reasoning through complex patient information under pressure.
- To enhance clarity, confidence, and communication during ICU triage decisions.
Main Methods:
- Development of a three-domain framework: Premorbid (baseline reserve), Morbid (present illness), and Postmorbid (outcome trajectories).
- Teaching the framework through case-based discussions in a high-volume medical ICU.
- Focus on integrating physiologic reserve, etiologic diagnosis, recoverability, and realistic outcome trajectories.
Main Results:
- The framework provides a structured method for reasoning through uncertainty in ICU triage.
- It facilitates clearer prognostication and communication among healthcare teams.
- Offers a shared language and cognitive scaffold for complex decision-making under pressure.
Conclusions:
- The Premorbid-Morbid-Postmorbid framework supports structured reasoning in ICU triage.
- It empowers trainees with a reproducible method for transparent communication and confident decision-making.
- This approach aids clinicians in navigating the complexities of ICU patient assessment and disposition.
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