Consider emergent transfer to ED (unless not congruent with goals of care*) if: HR >110, SPO2 consistently ≤ 92% despite O2, RR >24 Severe shortness of breath at rest (e.g. Breathlessness RR >30 despite normal O2 sats) Difficulty in breathing (work of breathing) Increasing O2 supplement requirements New pain or pressure in chest Decreased oral intake or urine output (dehydrated, needing IV fluids) Cold, clammy or pale mottled skin New onset of confusion, becoming difficult to rouse, syncope Blue lips or face Coughing up blood Other symptoms indicating severe illness, or significant or rapid deterioration. The patient’s risk factors for more severe illness should be considered in making the decision to refer to ED: age (>65), comorbidities as above, immunocompromised, higher frailty score. * see Managing Progressive Life Limiting Conditions (COVID and non COVID)