Urgent Consult Escalations

Urgent consults cannot sit in a queue

An emergency physician wants a patient seen tomorrow. A primary care office has a patient with a suspicious mass. A post-op patient's family calls about the wound. These calls are uncommon, but each one mishandled is serious for the patient and for the practice.

The danger is rarely that staff ignore them. It is that the urgent call looks like every other call until someone listens to it, and by then the morning is half gone.

Defining urgent before launch

Katie does not make clinical judgments, so urgency has to be defined by your physicians in terms a receptionist can apply. Good escalation rules name situations, not diagnoses.

• Any call from a hospital, emergency department or another physician about a shared patient
• A referring office asking for a visit within a timeframe they specify
• A recent surgical patient reporting a problem with the procedure site
• Any caller who says it is an emergency

What escalation looks like

During office hours, an urgent call can be transferred at once to the person you name: the triage nurse, a physician assistant, or the line your physicians designate. If nobody picks up, the caller's details and the reason for the call are captured and marked urgent.

After hours, the call follows your after-hours rules. Someone describing an emergency is directed to emergency services. Other urgent situations are handled the way your physicians specified, and the summary states the urgency plainly.

Reviewing escalations

Read the escalated summaries weekly for the first month. Look for calls that were escalated but did not need to be, and routine-looking calls that should have been. Each one is a rule to adjust, and adjusting a rule changes how every later call is handled.

Bring the physicians who wrote the rules into that review. They are the ones who can say whether a situation belongs on the urgent list.

Over-escalation has a cost too

It is tempting to mark everything that sounds clinical as urgent. Do that and the urgent flag stops meaning anything, and the nurse who receives ten urgent summaries a morning learns to treat them as routine. Keep the urgent list short and specific, and let ordinary clinical questions take the ordinary clinical route.

A good test: would your most experienced front desk person interrupt a physician for this call? If yes, it belongs on the list. If they would leave a message for the nurse, it probably does not.