Contributor: Nick Tsipis, MD Educational Pearls: Communication proves time and time again to be most helpful in preventing surprises after patient admission Frequent re-evaluations and repeat vital signs can be important to evaluating a patient’s risk for deterioration once admitted as well as selecting the proper level of care at admission Broad categories of patients who most commonly have a change in condition after admission are septic patients and those admitted for respiratory complaints References Kennedy M, Joyce N, Howell MD, et al. Identifying infected ED patients admitted to the hospital ward at risk of clinical deterioration and intensive care unit transfer. Acad Emerg Med. 2010;17(10):1080–1085.  Caterino JM, Jalbuena T, Bogucki B. Predictors of acute decompensation after admission in ED patients with sepsis. Am J Emerg Med. 2010;28(5):631–636. doi: 10.1016/j.ajem.2009.04.020. Wardi G, Wali AR, Villar J, et al. Unexpected intensive care transfer of admitted patients with severe sepsis. J Intensive Care. 2017;5:43. Published 2017 Jul 12. doi:10.1186/s40560-017-0239-7 Boerma LM, Reijners EPJ, Hessels RAPA, V Hooft MAA. Risk factors for unplanned transfer to the intensive care unit after emergency department admission. Am J Emerg Med. 2017;35(8):1154–1158. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD