After hours · On-call · Template
The after-hours escalation protocol every practice should write down
Physicians stop trusting an answering service the week it pages them for a refill at 1 a.m. The service is not being careless; it has no rules. Here is the one-page protocol that gives it some, whether a person or a receptionist follows it.
Why the pager goes off for everything
An operator with no protocol has one safe move: page. The physician, woken for the third non-urgent call, tells the office to 'only page for real emergencies', which is not a rule an operator can apply. Practice-manager forums are full of the result: an on-call who ignores pages, and a service nobody trusts. The fix is a written protocol that turns judgement into questions with answers.
The template
Copy this into a document, fill it in with your clinicians, and give it to whoever answers your line.
- Emergency words. A short list (chest pain, can't breathe, stroke signs, heavy bleeding, worst headache of my life, suicidal) that ends any screening: the caller is told to call 911, and the on-call is alerted that the call happened.
- Page now. The conditions that page the on-call immediately, by specialty. Orthopedics: fever over 101 after surgery, incision drainage, calf swelling, a cast that is too tight, new numbness. Write each as a question the caller can answer yes or no.
- Morning list. Everything else: refills, results, scheduling, billing, directions. It becomes a task with the caller's number and is worked when the office opens.
- The page itself. What it must carry: the caller's name, date of birth, callback number, the questions asked and the answers, and the time. A page that says 'patient called, please call back' is a page for everything.
- Acknowledgement. How the on-call confirms receipt (a tap on a secure link, a reply text) and how long the service waits before paging the backup: ten to fifteen minutes is common.
- Backup and the practice contact. Who is paged if the on-call does not acknowledge, and who at the practice is called if the backup does not either.
- The caller's instructions. What the caller is told while waiting ('expect a call within fifteen minutes; if X happens before then, call 911'), in words the practice approved.
- Review. Who reads last night's pages each morning, and how the protocol is changed when a page should not have happened or a call should have been paged.
Two examples of a good rule
| Bad rule | Good rule |
|---|---|
| Page for anything serious after surgery | After a joint replacement: page if fever over 101, redness or drainage at the incision, calf pain or swelling, or pain worse than yesterday. Otherwise morning list with the answers. |
| Use judgement on medication calls | Any question about a dose, an interaction or a side effect: morning list, with the medication named. Never advise. If the caller reports an overdose or a severe reaction: emergency words. |
How Callinzo uses it
The protocol is the receptionist's configuration. The practice's clinicians approve the screening questions; the answers travel with the page as a secure link; the on-call acknowledges by tapping it; the backup is paged after the interval the practice set; and the morning review is a screen. Every page can be read afterwards with the transcript, which is how the rules get better.