Feature deep dive

Call Routing and Triage: Rule Engine for Multi-Provider, Multi-Location, Safety-First Healthcare Calls

Most phone trees route on two or three variables, usually "press 1 for X" and a time-of-day check. Real medical practices need to route on dozens of axes at once, and they need a clinical triage layer that can recognize a stroke from a sore throat in seconds. This is the technical specification for how the MedReception AI rule engine resolves both problems on every call.

Rule Engine · Safety-First Routing

Routing Dimensions

Independent variables the engine resolves per call

Specialty Triage Modules

Cardiology, OB, peds, dental, behavioral, primary care

Safety Live-Transfer Rate

100%

Every hard safety trigger reaches a human or 911

Avg Triage Decision

4.2s

Median time from symptom statement to tier assignment

Routing dimensions

23 Variables Resolved on Every Call

Each incoming call is evaluated across all 23 axes in parallel. The engine resolves the cross-product into a single routing decision, which can be a calendar slot, a queue, a live transfer, or a structured callback. Dimensions are grouped here by category, but the engine treats them as a flat feature vector.

Provider and Operational

1. Provider preference (named clinician requested)
2. Provider availability and on-call schedule
3. Location or site (city, suite, room number)
4. Visit type (new patient, follow up, procedure, telehealth)
5. Day of week and holiday calendar
6. Time of day and after-hours window
7. Prior relationship (established vs first time caller)
8. Last visit recency and follow up status

Patient Attribute

9. Preferred language (English, Spanish, plus 18 more)
10. Age band (peds, adult, geriatric)
11. Active condition flags (pregnancy, post op, oncology)
12. Caller relationship (self, parent, caregiver, facility)
13. Hearing or speech accommodation flag
14. Geographic region for jurisdictional 911 routing
15. Communication preference (call back, SMS, portal)

Financial and Coverage

16. Payer (commercial, Medicare, Medicaid, self pay)
17. Insurance plan acceptance per provider
18. Referral or auth requirement
19. Outstanding balance and payment plan status
20. Network status (in network, out of network)

Clinical and Intent

21. Stated chief complaint mapped to ICD category
22. Triage tier assigned by the clinical layer
23. Call intent (book, reschedule, refill, results, billing, urgent)

Triage tiers

Four Clinical Triage Tiers

Every call that contains a clinical statement is bucketed into one of four tiers. The tier is what drives the downstream action. The engine never books a tier 1 caller and never transfers a tier 4 caller, by design.

Tier 1: Emergency, Immediate Transfer

Action: warm transfer to on call clinician, or instruct caller to dial 911
Timer: less than 5 seconds from trigger to transfer
No booking, no data collection beyond name and callback number
Logged with full transcript and timestamp to the safety audit table
Automatic SMS to the on call provider with caller phone and one line summary

Tier 2: Urgent, Same Day

Action: same day or next morning slot on first available provider
Engine overrides normal provider preference if no same day slot exists
Caller offered nurse callback within 30 minutes as fallback
Booked appointment is flagged URGENT in the EHR
Escalates to tier 1 if any red flag keyword appears mid call

Tier 3: Standard Booking

Action: full routing across all 23 dimensions, normal calendar logic
Default tier for follow ups, annual exams, and routine new patient calls
Insurance verification and intake forms triggered in parallel
Caller can request a specific provider, location, or time window
Conversion to confirmed booking is the primary success metric

Tier 4: Informational Deflection

Action: answer in line, no booking, no transfer
Covers hours, address, parking, fax, insurance acceptance, refill policy
Resolves about 28 percent of total call volume without staff touch
Always offers to convert to a booking if the caller raises a clinical topic
Frees staff for the 72 percent of calls that actually need them

Specialty triage modules

Six Specialty Triage Modules

Generic triage misses the things that matter to a cardiologist or an OB. Each specialty module ships with its own keyword set, age weighting, and red flag tree. Modules can be combined when a practice covers more than one specialty.

Cardiology Module

Chest pain plus diaphoresis or radiation triggers tier 1
New onset palpitations with syncope triggers tier 1
AICD shock event in last 24 hours triggers tier 1
Stable angina with known nitro use routes tier 2
Post procedure bleeding or hematoma routes tier 2

Obstetrics and Gynecology Module

Vaginal bleeding in pregnancy at any gestational age triggers tier 1
Regular contractions before 37 weeks triggers tier 1
Decreased fetal movement after 28 weeks triggers tier 2 with L and D callback
Severe pelvic pain plus fever routes tier 2
Postpartum heavy bleeding triggers tier 1

Pediatrics Module

Fever in infant under 3 months triggers tier 1
Fever over 39 in age 3 to 36 months routes tier 2
Difficulty breathing or retractions at any age triggers tier 1
Dehydration signs in age under 2 routes tier 2
Routine fever in healthy child over 3 routes tier 3 nurse callback

Dental Module

Facial swelling with fever or trismus triggers tier 1 ED routing
Avulsed permanent tooth triggers tier 1 with preservation instructions
Severe toothache with fever routes tier 2 same day
Post extraction bleeding longer than 30 minutes routes tier 2
Routine pain or sensitivity routes tier 3

Behavioral Health Module

Suicidal ideation with plan or intent triggers tier 1 to 988 or live clinician
Homicidal ideation triggers tier 1
Active psychosis or mania with safety concern triggers tier 1
Medication side effect screen routes tier 2 same day
Therapy intake and refills route tier 3

Primary Care Module

Stroke screen (FAST positive) triggers tier 1
Anaphylaxis signs triggers tier 1
New severe headache or worst headache of life triggers tier 1
Suspected DVT or PE routes tier 1
Standard URI, UTI, rash, and refill flows route tier 2 or 3

Safety triggers

Hard Safety Triggers: Never Booked, Always Transferred

These triggers bypass every other routing rule. They cannot be disabled by configuration, A/B test, or caller request. When a safety phrase is detected, the engine interrupts the current dialogue, reads a short reassurance script, and connects the caller to a live person or 911 within seconds.

Self Harm and Crisis

Suicidal ideation, plan, or intent
Active suicide attempt in progress
Overdose, accidental or intentional, current or recent
Homicidal ideation or threats toward others
Active domestic violence or assault in progress

Severe Medical Symptoms

Chest pain, pressure, or tightness with shortness of breath
Stroke signs: face droop, arm weakness, slurred speech
Severe difficulty breathing or stridor
Uncontrolled bleeding or active hemorrhage
Anaphylaxis: throat swelling, tongue swelling, full body hives plus breathing change

Pregnancy and Pediatric Red Flags

Active labor or membrane rupture
Vaginal bleeding in pregnancy
Infant under 3 months with fever
Child with blue lips, retractions, or unresponsiveness
Seizure, current or in last hour

Transfer Mechanics

Default target: on call clinician via existing phone tree
Fallback target: 911 with jurisdictional PSAP based on caller area code
Audit: every transfer logged with trigger phrase, tier, target, and outcome
Caller stays on the line while the transfer dials, never dropped
If transfer fails, engine reads the 911 script and the local emergency number

Configuration UI

Rules Editor, A/B Testing, and Override Audit Log

The rule engine is configured through a single web UI. Practice managers can edit routing trees, test new rules on a slice of live traffic, and review every override. No code, no waiting on engineering.

Visual Rules Editor

Drag and drop nodes for each routing dimension. Conditions evaluate left to right. Every rule has a human readable preview and a structured JSON export for version control.

23 dimensions exposed as first class fields

A/B Testing

Run two rule variants in parallel on a percentage of inbound calls. The engine reports booking rate, transfer rate, and average handle time per variant. Promote the winner in one click.

Sample sizes auto compute to 95 percent confidence

Override Audit Log

Every manual override, every rule edit, every safety trigger fire is written to an immutable audit log. Filter by user, date, rule id, or caller. Exportable for HIPAA and joint commission review.

7 year retention, append only

Failure modes

Failure Modes and Human Escalation

No rule engine catches everything. The system is designed so that any uncertainty escalates to a human, never the other way around. The default failure mode is always live transfer, not voicemail.

Ambiguity Triggers Escalation

Caller intent below confidence threshold escalates to staff
Conflicting answers across two questions escalate
Profanity, distress, or audible crying escalate
Background noise consistent with emergency escalates
Three consecutive misunderstood turns escalate

Caller Initiated Escalation

"Talk to a person" or "agent" at any turn triggers transfer
"Emergency" or "911" triggers tier 1 path
Repeated requests for a specific staff name route to that person
Spanish or other language switch mid call rebinds the module
Hearing or speech accommodation request triggers TTY routing

System Health Failures

EHR API timeout falls back to capture only and live transfer
Calendar provider outage triggers structured callback queue
LLM provider degradation routes to deterministic IVR fallback
Audio quality below threshold prompts caller to repeat or transfer
Every health failure paged to on call engineer within 60 seconds

Default to Human

Voicemail is never the terminal state for a tier 1 or tier 2 call
Off hours escalations go to the documented on call rotation
Practice can override the default target per location and per day
Failed transfers retry once, then read the 911 fallback script
Every failure mode is documented in the published escalation playbook

See the routing layer in context

How Healthcare-Wide Call Routing Connects

The triage rule engine is one half of the overall routing story. The healthcare hub page walks through the broader architecture, including queue logic, EHR sync, and reporting.

AI Call Routing for Healthcare

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Hear the Rule Engine on a Live Call

Book a demo and we will route a sample call through your specialty module, including a tier 1 safety trigger and a multi dimension booking.

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