[
  {
    "patient_id": "P1001",
    "decision": "Immediate Intervention Required",
    "confidence": 0.87,
    "risk_level": "High",
    "reasoning": [
      "Patient shows elevated vital signs: BP 165/98, HR 112",
      "Oxygen saturation below threshold at 91%",
      "Multiple comorbidities present (3): diabetes, hypertension, COPD",
      "Historical pattern indicates deteriorating trend over 48 hours",
      "Age-adjusted risk score exceeds critical threshold"
    ],
    "recommendations": [
      "Initiate continuous monitoring with 15-minute vital sign checks",
      "Consult pulmonologist for respiratory assessment",
      "Review and adjust current medication regimen",
      "Consider oxygen supplementation",
      "Prepare for potential ICU transfer if condition worsens"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "deteriorating",
      "lab_results": "abnormal inflammatory markers",
      "previous_admissions": 2,
      "response_to_treatment": "suboptimal"
    },
    "timestamp": "2025-10-31T10:15:23Z"
  },
  {
    "patient_id": "P1002",
    "decision": "Continue Standard Monitoring",
    "confidence": 0.92,
    "risk_level": "Low",
    "reasoning": [
      "All vital signs within normal ranges",
      "Oxygen saturation stable at 97%",
      "No active comorbidities or complications",
      "Patient responding well to current treatment plan",
      "No concerning trends in recent monitoring data"
    ],
    "recommendations": [
      "Maintain current 4-hour monitoring schedule",
      "Continue prescribed medication without adjustment",
      "Schedule routine follow-up in 24 hours",
      "Patient may be eligible for step-down care",
      "Encourage ambulation and physical therapy"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "stable",
      "lab_results": "all within normal limits",
      "previous_admissions": 0,
      "response_to_treatment": "excellent"
    },
    "timestamp": "2025-10-31T10:16:45Z"
  },
  {
    "patient_id": "P1003",
    "decision": "Increase Monitoring Frequency",
    "confidence": 0.78,
    "risk_level": "Medium",
    "reasoning": [
      "Borderline vital signs: BP 145/92, HR 95",
      "Slight downward trend in oxygen saturation (94%)",
      "Two comorbidities require closer attention",
      "Recent medication changes need evaluation",
      "Early warning score suggests increased vigilance needed"
    ],
    "recommendations": [
      "Increase monitoring to 2-hour intervals",
      "Conduct comprehensive nursing assessment",
      "Review medication efficacy and side effects",
      "Monitor fluid balance and intake/output",
      "Consult physician if any parameter deteriorates"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "slightly declining",
      "lab_results": "minor abnormalities",
      "previous_admissions": 1,
      "response_to_treatment": "moderate"
    },
    "timestamp": "2025-10-31T10:18:12Z"
  },
  {
    "patient_id": "P1004",
    "decision": "Critical Alert - Immediate Medical Team Notification",
    "confidence": 0.91,
    "risk_level": "Critical",
    "reasoning": [
      "Severely elevated vital signs: BP 178/105, HR 125",
      "Dangerously low oxygen saturation at 88%",
      "Multiple high-risk comorbidities (4): CHF, diabetes, renal insufficiency, COPD",
      "Rapid deterioration over past 6 hours",
      "Patient meets criteria for Rapid Response Team activation"
    ],
    "recommendations": [
      "IMMEDIATE: Activate Rapid Response Team",
      "Initiate emergency oxygen therapy",
      "Prepare for possible intubation and mechanical ventilation",
      "Transfer to ICU bed - coordinate with bed management",
      "Family notification and advance care planning discussion",
      "Stat labs: ABG, BMP, troponin, BNP"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "rapidly deteriorating",
      "lab_results": "critical abnormalities",
      "previous_admissions": 4,
      "response_to_treatment": "poor"
    },
    "timestamp": "2025-10-31T10:19:34Z"
  },
  {
    "patient_id": "P1005",
    "decision": "Consider Discharge Planning",
    "confidence": 0.89,
    "risk_level": "Low",
    "reasoning": [
      "All vital signs stable and within normal limits",
      "Oxygen saturation excellent at 98%",
      "No comorbidities or complications present",
      "Patient has met all treatment goals",
      "Risk assessment indicates safe for discharge"
    ],
    "recommendations": [
      "Initiate discharge planning process",
      "Provide patient education materials",
      "Schedule outpatient follow-up within 7 days",
      "Ensure medication reconciliation completed",
      "Arrange any necessary home health services"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "consistently stable",
      "lab_results": "all normal",
      "previous_admissions": 0,
      "response_to_treatment": "complete resolution"
    },
    "timestamp": "2025-10-31T10:21:08Z"
  },
  {
    "patient_id": "P1006",
    "decision": "Specialist Consultation Required",
    "confidence": 0.82,
    "risk_level": "Medium",
    "reasoning": [
      "Moderate vital sign abnormalities: BP 150/95, HR 98",
      "Oxygen saturation borderline at 93%",
      "Complex comorbidity interaction requires specialist input",
      "Treatment response has plateaued",
      "Risk of progression without specialist intervention"
    ],
    "recommendations": [
      "Request cardiology consultation within 24 hours",
      "Continue enhanced monitoring at 2-hour intervals",
      "Consider adjusting antihypertensive regimen",
      "Perform echocardiogram if not recently completed",
      "Optimize current medication for comorbidity management"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "plateaued improvement",
      "lab_results": "moderate abnormalities",
      "previous_admissions": 2,
      "response_to_treatment": "incomplete"
    },
    "timestamp": "2025-10-31T10:22:41Z"
  },
  {
    "patient_id": "P1007",
    "decision": "Urgent Intervention Needed",
    "confidence": 0.84,
    "risk_level": "High",
    "reasoning": [
      "Concerning vital signs: BP 168/102, HR 115",
      "Low oxygen saturation at 90%",
      "Three comorbidities with compounding effects",
      "Early signs of clinical deterioration detected",
      "Patient history indicates high risk for complications"
    ],
    "recommendations": [
      "Increase monitoring to continuous telemetry",
      "Initiate supplemental oxygen therapy",
      "Notify attending physician immediately",
      "Consider ICU consultation for bed availability",
      "Review and optimize current treatment plan",
      "Prepare family for potential status change"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "declining",
      "lab_results": "several abnormal values",
      "previous_admissions": 3,
      "response_to_treatment": "suboptimal"
    },
    "timestamp": "2025-10-31T10:24:15Z"
  },
  {
    "patient_id": "P1008",
    "decision": "Maintain Current Care Plan",
    "confidence": 0.88,
    "risk_level": "Low",
    "reasoning": [
      "Vital signs stable and improving: BP 128/82, HR 78",
      "Excellent oxygen saturation at 96%",
      "Single comorbidity well-controlled",
      "Positive response to current treatment",
      "No red flags or concerning trends identified"
    ],
    "recommendations": [
      "Continue current monitoring schedule (4-hour intervals)",
      "Maintain existing medication regimen",
      "Encourage continued improvement activities",
      "Routine reassessment in 24 hours",
      "Begin discussing transition planning"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "improving",
      "lab_results": "normalizing",
      "previous_admissions": 1,
      "response_to_treatment": "good"
    },
    "timestamp": "2025-10-31T10:25:52Z"
  },
  {
    "patient_id": "P1009",
    "decision": "Enhanced Observation Protocol",
    "confidence": 0.75,
    "risk_level": "Medium",
    "reasoning": [
      "Vital signs showing variability: BP fluctuating 135-152",
      "Oxygen saturation occasionally dipping to 94%",
      "One comorbidity with potential for complications",
      "Recent treatment adjustment requires monitoring",
      "Early intervention may prevent deterioration"
    ],
    "recommendations": [
      "Implement enhanced observation protocol (2-hour vitals)",
      "Monitor response to recent medication changes",
      "Encourage deep breathing exercises and incentive spirometry",
      "Conduct thorough nursing assessment twice per shift",
      "Maintain heightened alertness for any changes"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "variable",
      "lab_results": "minor abnormalities",
      "previous_admissions": 1,
      "response_to_treatment": "monitoring ongoing"
    },
    "timestamp": "2025-10-31T10:27:29Z"
  },
  {
    "patient_id": "P1010",
    "decision": "Emergency Medical Team Activation",
    "confidence": 0.89,
    "risk_level": "Critical",
    "reasoning": [
      "Critical vital signs: BP 180/108, HR 128, RR 28",
      "Severely compromised oxygen saturation at 87%",
      "Multiple severe comorbidities in decompensation",
      "Acute deterioration over 4-hour period",
      "Meets criteria for emergency medical intervention"
    ],
    "recommendations": [
      "IMMEDIATE: Activate Code Blue team standby",
      "Emergency oxygen therapy - non-rebreather mask",
      "Obtain stat arterial blood gas and critical labs",
      "Prepare for emergent intubation if respiratory failure progresses",
      "Immediate ICU transfer - bypass standard protocols",
      "Family notification - serious condition update",
      "Cardiology and pulmonology stat consults"
    ],
    "supporting_evidence": {
      "vital_signs_trend": "acute severe deterioration",
      "lab_results": "critical multiple abnormalities",
      "previous_admissions": 5,
      "response_to_treatment": "treatment failure"
    },
    "timestamp": "2025-10-31T10:29:03Z"
  }
]
