After-Hours

Some answers should not reach your on-call provider first — they should reach emergency care

Sudden severe onset, focal neurological deficits, fever, altered mental status. How a migraine practice writes the after-hours questions that place a caller on the emergency branch instead of the on-call branch.

Your practice authors the red-flag list, and the call asks it as questions rather than inferring a diagnosis
Answers matching your criteria place the caller on the emergency branch rather than the on-call branch
The on-call provider is still notified of an emergency-branch call, so nothing is routed away silently
Status migrainosus and refractory symptoms route to your on-call provider with history and current medications attached
Routine after-hours calls reach neither branch — they are queued for morning clinic staff
Every call is logged with the branch taken and the answers that put it there

How it pays back

The Branch Is Decided by Answers, Not by a Guess

Red flags are recognised because a caller answered a question about them, not because a model formed an impression. Sudden severe onset, focal neurological deficits, fever and altered mental status are asked about directly, and the routing follows the answers as given.

Two Urgent Branches, Not One

Treating everything urgent as one category is the mistake worth designing out. Status migrainosus routing to your on-call provider and a suspected emergency routing to emergency evaluation are both urgent and both time-critical, but they are different destinations with different wording.

Nothing Is Routed Away Silently

A caller directed to emergency evaluation is not a caller your practice loses sight of. The system can recommend ER referral and escalate to your on-call provider for confirmation, so the physician learns about it tonight rather than from a discharge summary next week.

The Criteria Are Reviewable Because They Are Written Down

Every call is tagged with its triage result and returned as a summary for chart documentation, so the red-flag list can be checked against the calls it actually fired on. A criterion that never fires and one that fires constantly are both worth knowing about.

The Caller Is Told What to Do Next, in Your Words

Urgent and emergent presentations get different guidance, and both use the wording your practice authored — when to recommend emergency evaluation, when to wait for the on-call provider, when an urgent next-day visit is the answer.

Urgent calls escalated instantly

Status migrainosus and refractory symptoms trigger real-time on-call provider contact

Patient context captured

History, current medications, severity, and triggers all recorded before on-call provider is contacted

Chart context available

Your on-call provider can reference the patient's migraine history and medications during the call

Call logged with outcome

Every after-hours call is tagged with triage result and returned as a summary for chart documentation

Frequently asked questions

Can the system recommend that a patient go to the emergency department?

It applies the red-flag criteria your practice defined. Sudden severe onset, focal neurological deficits, fever, altered mental status and suspected meningitis are the presentations practices commonly configure for immediate emergency evaluation, and the system can recommend ER referral and escalate to your on-call provider for confirmation.

Who decides which symptoms count as red flags?

Your practice does. The criteria are yours to author and to revise, which is what makes the routing defensible afterwards, because each branch traces back to a written rule rather than to an on-the-night judgement.

Does an emergency-branch call still notify the on-call provider?

Yes. The recommendation and the escalation happen together, so your on-call provider is aware of the call and can confirm or intervene rather than discovering it later.

How quickly does triage run before a branch is taken?

The call asks the initial triage questions — symptom onset, severity, associated symptoms — and if the answers flag it as urgent, it immediately attempts to reach your on-call provider. Total triage time is typically 2-3 minutes.

What happens to a status migrainosus call specifically?

It takes the on-call branch rather than the emergency one. Your provider receives the patient's name and date of birth, current severity, onset time and duration, prior treatment attempts, current medications, known triggers and associated symptoms, and the patient may still be on the line.

Is the branch decision itself logged?

Yes. Every after-hours call is tagged with its triage category and the outcome, and returned as a structured summary your staff can review and file to the patient record.