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Routing Specialty Care Telephone Calls – Adult/Pediatric – Ambulatory

Routing Specialty Care Telephone Calls – Adult/Pediatric – Ambulatory - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, In the Clinic


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Routing Specialty Care Telephone Calls
- Adult/Pediatric - Ambulatory
Clinical Practice Guideline
Note: Active Table of Contents – Click to follow link
Table of Contents
EXECUTIVE SUMMARY ............................................................................ 3
SCOPE ....................................................................................................... 3
METHODOLOGY ....................................................................................... 4
INTRODUCTION ........................................................................................ 5
RECOMMENDATIONS .............................................................................. 5
Process ................................................................................................ 5
General Considerations ....................................................................... 5
Patient Prioritization in Specialty Care ................................................. 7
UW HEALTH IMPLEMENTATION ............................................................. 9
APPENDIX A. COORDINATING TEAM MEMBERS ................................ 10
APPENDIX B. SPECIALTY SPECIFIC CARE PRIORITIZATION ............ 12
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

2
CPG Contact for Content:
Name: Department of Clinical Staff Education
Email Address: staff.educators@uwmf.wisc.edu
CPG Contact for Changes:
Name: Lindsey Spencer, MS- Center for Clinical Knowledge Management (CCKM)
Phone Number: (608) 890-6403
Email Address: lspencer2@uwhealth.org
Guideline Author(s):
Linda Vesterdahl, MSN, RN- Clinics Administration
Tracy Crowley, BSN, RN- Clinical Staff Education
Coordinating Team Members:
See Appendix A for physician and clinic manager names.
Review Individuals/Bodies:
Primary Care Executive Team
Care Model Oversight Group (CMOG)
Committee Approvals/Dates:
U-WISCO (07/16/15)
Clinical Knowledge Management (CKM) Council (10/22/15)
Release Date: October 2015 | Next Review Date: October 2016
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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Executive Summary
Guideline Overview
This document provides reception/scheduler staff with guidance for the expected
documentation and appropriate routing of telephone calls based upon problems or
complaints expressed by a patient or their family member.
Key Practice Recommendations
1. Reception staff will quote the patient when documenting and will not interpret or
advise. Reception staff may NOT offer medical advice, personal opinion, offer
triage, or refer patients to Urgent Care or the Emergency Department.
2. For EMERGENT conditions, immediately transfer the caller to RN or Provider.
3. For URGENT conditions, attempt to warm transfer caller to RN.
4. For ROUTINE conditions, routing will be to the RN Pool or to the appropriate Clinical
Pool (RN/LPN/MA).
Pertinent UW Health Policies & Procedures
1. UW Health Guideline for Routing of Message between UW Health Locations and
Departments
2. Health Link Training- Routing of Messages Between UW Health Locations and
Departments
3. UW Health Clinical Policy 8.07- Procedures, Communication of Critical Results and
Critical Tests
Patient Resources
1. Health Facts For You #7531- Calling Guidelines for Transplant Recipients
2. Health Facts For You #7637- Ambulatory Telephone Nurse Triage at UWHC
Scope
Disease/Condition(s): Incoming clinic telephone calls
Clinical Specialty: Specialty Care
Intended Users: Reception/Schedulers
Objective(s): To provide reception/scheduler staff with expectations for
documentation and routing of incoming clinic telephone calls.
Target Population: Adult and pediatric patients (or their guardians) calling a
specialty care clinic via telephone.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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Methodology
Methods Used to Collect/Select the Evidence:
Electronic database searches (e.g., PUBMED) were conducted by the guideline
author(s) and workgroup members to collect evidence for review. Expert opinion and
clinical experience were also considered during discussions of the evidence.
Methods Used to Formulate the Recommendations:
The workgroup members arrived at a consensus through discussion of the literature and
expert experience. All recommendations developed or endorsed by the guideline
workgroup were reviewed and approved by other stakeholders or committees (as
appropriate).
Methods Used to Assess the Quality of the Evidence/Strength of the
Recommendations:
Internally developed recommendations, or those adopted from external sources without
an assigned evidence grade, were evaluated by the guideline workgroup using an
algorithm (see Figure 1) adapted from the methodology developed for Grading of
Recommendations Assessment, Development and Evaluation (GRADE).
Figure 1. GRADE Algorithm
Rating Scheme for the Strength of the Evidence/Recommendations:
GRADE Ranking of Evidence
High We are confident that the effect in the study reflects the actual effect.
Moderate We are quite confident that the effect in the study is close to the true effect, but it is also
possible it is substantially different.
Low The true effect may differ significantly from the estimate.
Very Low The true effect is likely to be substantially different from the estimated effect.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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GRADE Ratings for Recommendations
Strong for using/Strong against using The net benefit of the treatment is clear, patient values and
circumstances are unlikely to affect the decision.
Weak for using/ Weak against using The evidence is weak or the balance of positive and
negative effects is vague.
Introduction
This document provides reception/scheduler staff with guidance for the expected
documentation and appropriate routing of telephone calls based upon problems or
complaints expressed by a patient or their family member.
Recommendations
Process
Telephone calls from patients or those concerning the patient’s clinical care will be
documented in Health Link as a Telephone Encounter. A telephone encounter gives
UW Health the ability to document the interaction with the patient, or on behalf of the
patient, and then be able to find that interaction afterward in Chart Review. If the
concern or call is “emergent” or an immediate response is required,
reception/scheduler will create a telephone encounter in addition to calling or
paging clinical staff/providers.
“RE: Patient” messages are not part of the legal medical record. They can be seen only
within the internal Health Link messaging system. These messages are not easily
tracked and cannot be linked to one another without more extensive data collection
behind the scenes. Therefore, RE: Patient messages should be used for communicating
NON-CLINICAL information or for coordinating care regarding information that is
already documented in the medical record. Refer to the UW Health Link Guideline for
Routing of Message between UW Health Locations and Departments for specific routing
information.
General Considerations
A. Reception will select the correct patient using a minimum of two patient identifiers
(name and date of birth) and include the preferred call back phone number as part of
the message taking process.
B. Telephone Encounters will be created using the appropriate Smart Phrase when
information or action is requested by or on behalf of a caller to the clinic (if no MRN
exists, please follow new patient registration guidelines). Calls should then be
routed to the provider or the department’s RN or MA/LPN Pool. Notes should
include pertinent information including “second call to clinic” and “returning clinic’s
call.” Call backs should be added to the call pending in that clinic/department’s
telephone encounter.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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This may include, but is not limited to, calls pertaining to the following:
ξ Test results
ξ Medication requests
ξ Orders for test(s) requested
ξ Appointment requests not accommodated
ξ Referrals to another Specialty
ξ Advice/Health Concerns
o Incoming calls related to health concerns should be handled using the
Patient Prioritization Guidelines in response to the patient or caller
reporting the items listed
o For reports of health concerns not listed on the Call Prioritization
Guidelines, a Telephone Encounter should be created and routed to the
department’s clinical pool for appropriate handling
ξ Information from the electronic medical record
ξ Symptomatic calls
ξ Self-reported readings
ξ General message
C. Reception staff will quote the patient when documenting and will not interpret
or advise. Reception staff may NOT offer medical advice, personal opinion, offer
triage, or refer patients to Urgent Care or the Emergency Department.
Example: Patient states “My stomach pain seems worse”;
ξReceptionist will document: Patient reports, “My stomach pain seems worse.”
ξReceptionist should NOT document Patient is not improving, is getting worse.
o One is a quote and the other is a clinical assessment
o Clinical assessment is NOT the role of the receptionist
ξReceptionist will NOT ask additional clinical-related questions, such as
o “What have you done for your stomach pain?”
ξReceptionist will NOT make suggestions such as: You should take Tums.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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Patient Prioritization in Specialty Care
A. For EMERGENT conditions, immediately transfer the caller to RN or Provider.
(UW Health Very low quality evidence, weak recommendation) Keep the patient on the line
until you reach a RN or Provider. Receptionist or Scheduler should create and
route a telephone encounter, high priority, including, but not limited to patient
name, MRN number and callback number.
Immediately transfer the caller to RN or Provider if patient reports any of the following
emergent situations: “911 type of calls”
Adult Patient – Emergent Conditions Pediatric Patient - Emergent Conditions
Chest pain “Discomfort or pressure in chest”
Rapid heart rate “pounding heart”
Irregular heart rate “skipping a beat”
Fever in an infant under age 3 months of age
Difficulty breathing with or without wheezing
Shortness of breath
Difficulty breathing
Wheezing
Difficulty swallowing Difficulty swallowing
Swallowed an object “my child swallowed…”
Uncontrolled bleeding; bleeding that will not stop Uncontrolled bleeding; bleeding that will not stop
Headache – “Worst ever”
Slurred speech
Loss of vision
Blurred or double vision
Facial weakness or facial “droop”
Head, neck or eye trauma/Injury
Head trauma with behavior changes/vomiting
Seizure – new onset
Fell and hit head
Loss of consciousness; “Blacked out”
Seizure
Fell and hit head
Loss of consciousness; “Blacked out”
Allergic reactions- rash or hives, throat swelling, or itching
(e.g. Bee sting, food or medication)
Allergic reactions- rash or hives, throat swelling,
or itching (e.g. Bee sting, food or medication)
Muscle weakness/Paralysis – “Loss of movement”
Numbness of any body part
New fracture
Possible poisoning or overdose, including medications,
chemicals, carbon monoxide, etc.
Provide Poison Control number 1-800-222-1222
Poisoning, ingestion or drug overdoses, including
medications, chemical, carbon monoxide, etc.
Provide Poison Control number 1-800-222-1222
Vomiting or Coughing up blood Burns, including chemical and electrical burns
Comments regarding physical abuse (sexual
or non-sexual)
Suspected child abuse (sexual or non-sexual)
Suicide (or other self-harm) threat/attempt
Homicidal (cause injury to others) threat /attempt
Suicide (or other self-harm) threat/attempt
Homicidal (cause injury to others) threat/attempt
Critical Lab/Test Results (UWHC locations follow Critical Lab
Result Policy 8.07)
Critical Lab/Test Results
Pregnant woman with:
a. Abdominal/Back pain or Contractions
b. Bleeding, Abnormal vaginal discharge
or Leaking fluid
c. Motor vehicle accident
d. Fever ≥101°F
e. Decreased fetal movement – “baby not moving”
Abdominal or testicular pain
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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B. For URGENT conditions, attempt to warm transfer caller to RN. (UW Health Very
low quality evidence, weak recommendation) If RN is not available, notify any RN there is
an urgent message. Receptionist/Scheduler should create and route a telephone
encounter, high priority, including, but not limited to patient name, MRN number and
callback number.
Attempt to warm transfer the caller to any RN if patient reports any of the following
urgent situations:
Adult Patient – Urgent Conditions
Fever ≥103° F
(exceptions: surgical, pregnant, or oncology patients
& DHC – check their specific guidelines)
Uncontrolled pain
Patient states: “Severe, excruciating, worst ever”
Dizziness – sudden onset Rectal bleeding “blood in stool or bleeding with a
bowel movement”
Burns, including chemical and electrical burns Fainting “passed out”
Fall with or without obvious injury
Any trauma, accident, or injury Abdominal pain – new or sudden onset
Blood Pressure “patient reports too high or too low” Patient insistence or upset/demanding patient
High or low blood sugar per the patient Pharmacy or lab calling with patient waiting
Recurrent seizure Calls regarding Coumadin, warfarin or blood thinners
Recent surgery/Post-op procedure:
“having problems” other than emergent conditions
listed above
a. problems with incision
ξ redness or swelling at incision
ξ pus, drainage, or bleeding from incision
b. chills, fever or temperature ≥101° F
c. increased pain
d. nausea/vomiting
e. calf pain/tenderness, redness, warmth, swelling
Dislocation of joint
New or suspected fracture
Patient states: “I think I broke my…”
C. For ROUTINE conditions, routing will be to the RN Pool or to the appropriate
Clinical Pool (RN/LPN/MA). (UW Health Very low quality evidence, weak recommendation)
1. Route to RN Pool, marked as routine, for calls for both adult and pediatric patients.
Examples of routine conditions to route to RN Pool include:
ξ No improvements in symptoms
ξ Lab results
ξ Appointment requests for today/this week when none are available
ξ Fracture follow-up
ξ Self-reported readings
ξ Nursing Home and Hospice calls
ξ Health related questions
ξ Patient/Parent/Guardian asks to speak with a nurse
ξ Other symptom-based calls not listed
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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2. Route to appropriate Clinical Pool (RN/LPN/MA), marked as routine, for calls for
both adult and pediatric patients. Examples of routine conditions to route to appropriate
Clinical Pool include:
ξ Request or questions regarding forms
ξ Information from the EHR
ξ Primary Care/Other Specialty clinics needing
information
ξ Referral Request to another Specialty clinic
ξ Request to have lab or other tests
ξ Medication refill requests
D. Additional specialty specific call prioritization guidelines are documented in
Appendix B: Specialty Specific Care Prioritization. (UW Health Very low quality evidence, weak
recommendation)
UW Health Implementation
Potential Benefits:
ξ Patient satisfaction
ξ Timely access to medical information and referrals
Potential Harms:
ξ Patient dissatisfaction
ξ Liability
ξ Remaining on hold
Implementation Plan/Tools
1. Guideline will be housed on U-Connect in a dedicated folder for CPGs.
2. Release of the guideline will be advertised in the Clinical Knowledge Management
Corner within the Best Practice newsletter.
3. Links to this guideline may be added within the Telephone Encounter Navigator
Health Link.
Disclaimer
CPGs are described to assist clinicians by providing a framework for the evaluation and
treatment of patients. This Clinical Practice Guideline outlines the preferred approach
for most patients. It is not intended to replace a clinician’s judgment or to establish a
protocol for all patients. It is understood that some patients will not fit the clinical
condition contemplated by a guideline and that a guideline will rarely establish the only
appropriate approach to a problem.
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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Appendix A. Coordinating Team Members
Physicians
Michael Ritter, MD- Pediatrics- Allergy
Sameer Mathur, MD, PhD- Medicine- Allergy
Richard Webb, MD- Psychiatry- General
Charles Stone, MD, FACC- Medicine- Cardiology
Annie Kelly, MD- Medicine- Cardiology
Patrick Pfau, MD- Medicine- Gastroenterology
Vanessa Rein, MD- Medicine- Endocrinology
David Upton, MD- Surgery- ENT/Otolaryngology
Timothy McCulloch, MD- Surgery- ENT/Otolaryngology
Roland Vega, MD- Surgery- General Surgery
Herbert Chen, MD- Surgery- General Surgery
Dan Lebovic, MD- OB/GYN- Endocrinology
Dobie Giles, MD- OB/GYN- Benign Gynecology
David Andes, MD- Medicine- Infectious Disease
Roy Jhagroo, MD- Medicine- Nephrology
Anne Weiss, DO- Neurology- General
John Kuo, MD, PhD- Neurological Surgery- General
Cynthia Anderson, MD, MPH- OB/GYN- General
Joel Henry, MD- OB/GYN- General
Gregory Bills, MD- OB/GYN- General
Sarah Bradley, MD- OB/GYN- General
David Hei, MD- Medicine- Hematology/Oncology
Richard Lemon, MD- Ortho/Rehab- Orthopedic General
Warren Dunn, MD, MPH- Ortho/Rehab- Orthopedic General
Alaa Abd-Elsayed, MD- Anesthesiology- General
Michael Bentz, MD- Surgery- Plastic
Bradley Manning, MD- Surgery- Plastic
James Runo, MD- Medicine- Pulmonary
Charles Weber, MD- Medicine- Pulmonary
Bethaney Anderson, MD- Human Oncology- General
Michael Walsh, DO- Medicine- Rheumatology
Jon Arnason, MD- Medicine- Rheumatology
James Maloney, MD- Surgery- Cardiothoracic
Michael Bentz, MD- Surgery- Plastic
David Paolone, MD- Urology
Stephen Nakada, MD- Urology
Jon Matsumura, MD- Surgery- Vascular Surgery
Maria Stanely, MD- Pediatrics- Child Development
Ruth Benca, MD, PhD- Psychiatry- General
Roderick Hafer, MD- Psychiatry- Immediate Treatment Clinic
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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Clinic Managers
Donna Croxford- Clinic Manager- Neurology- General
Jennifer Bellehumeur- Clinic Manager- Infectious Disease & Immunology
Heidi Smedal- Surgery- Audiology/Hearing
Michael Waupoose- Psychiatry- General
Susan Cabelka- Clinic Manager- Medicine- Cardiology
Hannet Tibagwa-Ambord- Pharmacy- Inpatient Services
Jason Davis- Clinic Manager- Rheumatology- West Clinic
Cheryl Heding- Clinic Manager- Surgery- ENT/Otolaryngology
Katina Kaufman- Clinic Manager- Otolaryngology
Donnette Kelly- Clinic Manager- Ortho/Rehab- Orthopedic General
Rebecca Hagen- Clinic Manager- General Surgery
Vicki Slager-Neary- Clinic Manager- Generations Fertility Clinic
Karen Schlageter- Clinic Manager- Wisconsin Dialysis
Christy Hunter- Clinic Manager- Neurology
Amy Berlin- Clinic Manager- OB/GYN- General
Joleen Sisler- Clinic Manager- Clinic Management- General
Nicole Smithback- Clinic Manager- Clinic Management- General
Elizabeth Kolk- Clinic Manager- Women’s Health- Internal Medicine- West
Cheryl Andree- Clinic Manager- Clinic Management- General
Julie Nampel- Clinic Manager- Medicine- Hematology/Oncology
Mary Sue Reilly- Clinic Manager- Ophthalmology
Ellen Heiser- Clinic Manager- Orthopedics
Tammy Yambor- Radiation Oncology- Administration
Anne Buol- Clinical Support- Cosmetic Services
Nancy Jones- Clinic Manager- Transplant & Podiatry
Zachary Lenhart- Urology
Jenna White- Clinic Manager- Surgery- Peripheral Vascular
Amy Whitehead- Waisman Center
Lori Zemlicka- Wisconsin Sleep
Jeanie Jundt- Clinic Manager- Psychiatry- General
Mark Shepherd- Clinic Manager- Orthopedic Surgery
Cheryle Sickels- Clinic Manager- Sports Medicine- Research Park
Marcus Kip Schick- Clinics- Administration- Research Park
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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Appendix B. Specialty Specific Care Prioritization
CLINIC EMERGENT CONDITIONS URGENT CONDITIONS
ALLERGY Signs of severe allergic reaction: (Anaphylaxis)
ξ LUNG: short of breath, wheeze, repetitive cough, difficulty breathing
ξ HEART: pale, blue, faint, weak pulse, confused, feeling of impending doom, passing
out, chest heaviness/pain
ξ THROAT: tight, hoarse, trouble breathing or swallowing, trouble talking
ξ MOUTH: swelling of tongue or lips
ξ SKIN: many hives over body, facial swelling, prominent itching of palms, soles, armpits,
or groin
ξ GUT: vomiting, cramping pain, nausea
Report of accidental food ingestion
Symptoms developing after an Immunotherapy Injection given earlier in the day
Worsening asthma/difficulty breathing
Breathing difficulties – New onset
Report of an active, severe, allergic reaction to a medication, bee sting or other
Signs of an allergic reaction:
ξ LUNG: coughing, mild increase in asthma symptoms
ξ HEART: dizziness, lightheadedness
ξ THROAT: tickle in throat, scratchy throat, hoarseness
ξ SKIN: hives or swelling
ξ GUT: nausea, vomiting, or diarrhea not associated with other symptoms
Fever, productive cough, difficulty breathing
AUDIOLOGY Broken or lost hearing aid(s)
BEHAVIORAL
HEALTH
Possible alcohol/drug overdose - (Adult and Pediatric)
Possible alcohol/drug withdrawal - (Adult and Pediatric)
ξ anxiety/depression, shakiness, sweating, nausea/vomiting, unable to sleep,
irritability, headaches
DIGESTIVE
HEALTH
CENTER
Post procedure:
ξ Abdominal pain
ξ Bleeding – New onset or more than usual
ξ Pain – New onset or more than usual
Post-operative symptoms:
ξ Drainage from incision: New onset or more than usual
ξ Fever greater than 100⁰ Fahrenheit
Newly diagnosed or calls related to a mass, cyst, lesion, or cancer
(malignancy/neoplasm)
Difficulty swallowing – New onset or change in difficulty swallowing
ENT Sudden hearing loss
Nose bleeds
Severe throat pain, difficulty opening mouth and swallowing, or fever (worsening
Tonsillitis)
Eye swelling or “puffy eyes” (Peri-orbital swelling)
Facial fracture - New onset
Nasal fracture - New onset
GENERAL
SURGERY
Drain tube problems
Melanoma - route encounter high priority if unable to schedule within 5 days
Breast cancer - route encounter high priority if unable to schedule within 5 days
KIDNEY CLINIC Seizure - New onset
Confusion - New onset
Mental status changes
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org

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CLINIC EMERGENT CONDITIONS URGENT CONDITIONS
NEUROLOGY Seizure – (Adult and Pediatric)
ξ Current seizure activity
ξ Train/cluster of seizures – multiple seizures in a short period of time
ξ Seizure lasting longer than 3 minutes
Slurred speech – New onset or change in speech
Blurred or Double Vision – New onset or change in vision
Muscle weakness/Paralysis - New onset or change in weakness or motor function
Numbness of any body part – New onset or change in numbness
ONCOLOGY Fever greater than 100.4⁰ Fahrenheit
OPHTHAL-
MOLOGY
New Onset of the following:
ξ Blunt or Penetrating trauma to eye
ξ Chemical splashes and burns to eye
ξ Scratched eye/cornea (Corneal abrasions)
ξ Decreased or distorted vision
ξ Double vision (Diplopia) – on grid
ξ Eye pain or injury
ξ Flashes/flashing lights or Floaters
ξ Loss of vision – on grid
ξ Surgery complication
ξ Swelling of the eye lid/eye socket with redness around the eye (Cellulitis)
ξ Droopy lid (Ptosis)
New onset or change in the following:
ξ Discharge/”pinkeye”
ξ Tearing (epiphora)
ξ Foreign body sensation
ξ Glare/halos around light
ξ Headaches
ξ Itching
ξ Eye lid swelling with pain (Chalazion/Stye/Cyst)
ξ Eye lid twitch (Myokymia)
ξ Unable to open eye (Blepharospasm)
ξ Light sensitivity (Photophobia)
ξ Loss of vision – on grid
ξ Persistent discomfort in an eye / discomfort with contacts
ξ Red or “bleeding eye”
ORTHOPEDIC/
SPINE
Bladder or bowel change (inability or difficulty urinating, incontinence) and/or numbness,
weakness or pain in legs (Cauda Equina)
PODIATRY
Sutures coming undone
Pin in foot moving
Saturated, bloody dressing
Bandages becoming wet
Nausea from medications
Increasing pain in foot/ankle or requesting more pain medication
THORACIC
SURGERY Chest tube problems
UROLOGY
Testicular pain (Adult and pediatric)
Testicular mass
Unable to urinate (Urinary retention)
Consistently bloody urine with or without “blood clots” (Gross hematuria)
Difficulty urinating or painful urination in men (Prostatitis)
New onset back pain with/without fever (Kidney stones or infection)
VASCULAR
SURGERY
Aneurysm patients:
ξ Back pain
ξ Stomach pain
Thoracic Aortic Aneurysm patients:
ξ Hoarse voice
ξ Difficulty swallowing
ξ Difficulty walking or leg weakness
New acute discoloration in legs or arms
New onset of severe leg pain
New onset of arm pain
New onset of leg swelling
WAISMAN –
BIO CHEMICAL
GENETICS
Consult MD:
ξ Abnormal newborn screen
ξ Critical lab results
Carotid patients:
ξ Hoarse voice
ξ Difficulty swallowing
Sick calls (RN/MD):
ξ Fever, vomiting, poor oral intake, lethargy
Copyright © 2015 Univ ersity of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2015CCKM@uwhealth.org