Last reviewed
2026-02-07
Workflow pack
Nausea/vomiting outpatient workflow
Workflow for dehydration-risk assessment, supportive management, and escalation when oral-intake failure persists.
Trust and governance
Use only within this workflow's defined scope and exclusions.
Clinical owner
Family Medicine Editorial Team
Risk tier
Medium
Review cadence
Every 6 months
Next due 2026-08-07
Review status
Current
Scope limits
Initial outpatient management of nausea/vomiting in clinically stable adults and adolescents.
Exclusions (escalate/redirect)
- Persistent hemodynamic instability or severe dehydration requiring urgent IV pathway.
- GI bleeding or severe focal abdominal pathology requiring emergency care.
References
Escalate-now emphasis (medium-risk workflow)
Treat red-flag findings as urgent. Escalate the care pathway early if concern persists or follow-up reliability is uncertain.
At a glance
Rapid decision framing for in-visit use. Educational only; always apply clinical judgment.
Immediate actions
- Evaluate fluid tolerance, orthostatic symptoms, and dehydration risk quickly.
- Screen for high-risk causes including bleeding, severe pain, and pregnancy context.
- Determine whether safe oral rehydration pathway is feasible.
Red flags / escalate now
- Inability to maintain oral intake with progressive dehydration signs.
- GI bleeding, severe abdominal pain, confusion, or hemodynamic compromise.
- Worsening systemic illness in high-risk comorbidity settings.
First-line plan
- Start hydration-first management with symptom-guided outpatient treatment.
- Use targeted investigations only when results will change immediate decisions.
- Set explicit escalation triggers if expected recovery does not occur.
Follow-up and monitoring
- Reassess early if oral intake remains poor or symptoms persist.
- Escalate for worsening dehydration, pain, or systemic instability.
- Reinforce clear return precautions and hydration goals.
Condition guidance
Referral checklists
Tools and calculators
Return precautions (patient script)
Suggested plain-language wording for safety-net counseling:
If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.
- Use with the specific red flags listed on this page.
- Confirm follow-up timing and where to go after-hours.
- Document that return precautions were reviewed and understood.
Visit-close checklist
- Document disposition, rationale, and unresolved diagnostic uncertainty.
- Give explicit return precautions and follow-up timeline before ending visit.
- Attach a relevant handout when available to reinforce adherence and safety-netting.