Primary on-call, then backup, then what? Decide the ladder before the night you need it.

Chest pain, shortness of breath, severe allergic reaction, uncontrolled bleeding, difficulty speaking or moving, sudden severe headache, loss of consciousness and similar red flags. You configure the list of conditions and keywords that trigger immediate escalation, so the threshold matches your practice rather than a generic default.

You supply the phone numbers for your on-call rotation. The provider's cell phone is called and the patient's information is presented in real time, so they are hearing the situation rather than being asked to call an unknown number back.

Three things, and the ladder should say which you expect: speak to the patient directly, give advice back through the call, or direct the patient to the ED. Writing down which of these applies to which category of call is most of what an escalation protocol is.

The backup on-call number is tried, then escalation continues to the practice manager or nurse line, or — if you configure it that way — the patient is advised to call 911 or go to the nearest ED. You set the hierarchy; the important part is that every rung has been decided in advance.

At an instruction the patient can act on without anyone else answering a phone. For most practices that is 911 or the nearest emergency department. A ladder whose last rung is another number that might not answer is not finished.

No. Your existing practice number can be configured to route to the AI outside business hours, so calls to your main line move into the after-hours path automatically on evenings and weekends without a new number being issued or advertised.