Cleaning up
Formal Definition
A subjective clinical observation that a patient's vitals and clinical trajectory are trending toward improvement — typically temperature normalization, heart rate settling, blood pressure stabilizing, mental status clearing, and laboratory markers trending in the right direction; used informally during signout or handoff to convey that a sick patient is heading the right way.
How It's Used on the Ward
"They're cleaning up" or "looking better" — the patient's fever is breaking, the white count is dropping, the pressor requirement is decreasing; the trajectory is favorable and the team is cautiously optimistic.
Example
""48h into antibiotics, the patient is cleaning up: T 37.4 from 39.1, WBC down from 18.4 to 11.2, lactate cleared from 4.1 to 1.6, pressor requirement weaned off overnight. Afebrile, satting well on RA, taking PO. Looking good.""
Clinical Context
A multi-parameter judgment — never based on a single vital sign. Components: temperature curve (afebrile >24h is the most reassuring), hemodynamic stability (no longer requiring vasopressors, HR settling into normal range), respiratory status (FiO2 requirements decreasing, no longer tachypneic), mental status (back to baseline, no longer altered), inflammatory markers (WBC trending down, lactate normalized for sepsis). Used during signout to set expectations for the cross-cover ("they're cleaning up but not out of the woods — watch for X, Y, Z"). Implication: discharge planning can begin. Opposite: "looking worse" or "going south" — deterioration discussion.