Clinic Updates

Purpose
To establish a standardized process for managing telephone calls from patients reporting cardiac symptoms, ensuring timely clinical assessment, appropriate provider involvement, and safe patient care.
Policy Statement
Front office staff are not responsible for assessing, interpreting, or advising patients regarding medical symptoms. Any patient reporting cardiac symptoms by telephone must be immediately transferred to or communicated to the clinical nursing staff for assessment.
Procedure
Step 1: Front Office Responsibilities
If a patient calls reporting symptoms that may be cardiac in nature, front office staff should:
Remain calm and courteous.
Obtain the patient’s name, date of birth, and a callback number.
Immediately notify a nurse or transfer the call to the nursing staff.
Do not provide medical advice or recommendations.
Do not place the patient on hold longer than necessary if they are reporting active symptoms.
If a patient reports symptoms suggestive of a medical emergency, including but not limited to severe or crushing chest pain, severe shortness of breath, loss of consciousness, symptoms of a heart attack, or symptoms of a stroke, the patient should be instructed to hang up and call 911 immediately or proceed to the nearest emergency department. Front office staff should immediately notify the nursing staff of the situation.
Examples of symptoms requiring immediate nursing notification include:
Chest pain or chest pressure
Shortness of breath
Palpitations
Dizziness or lightheadedness
Syncope or near syncope
Rapid or slow heart rate
Elevated or low blood pressure with symptoms
New or worsening swelling
Any symptom the patient believes may be heart-related
Step 2: Nursing Assessment
The nurse will promptly assess the patient’s reported symptoms, obtain all pertinent clinical information, and determine the urgency of the situation.
Information obtained should include, when applicable:
Onset and duration of symptoms
Severity and progression
Associated symptoms
Home blood pressure and heart rate readings, if available
Current medications and any recent medication changes
Any interventions the patient has already tried
Step 3: Provider Communication
Following the nursing assessment, the provider should be contacted promptly for further evaluation and treatment recommendations.
If the provider is temporarily unavailable, the nurse should continue monitoring the situation and use clinical judgment while awaiting provider guidance.
Step 4: Emergency Situations
If, based on the nursing assessment, the patient appears to be experiencing a potentially life-threatening cardiac event and the provider cannot be reached in a timely manner, the nurse should instruct the patient to call 911 immediately or proceed to the nearest emergency department, depending on the patient’s condition.
Examples include, but are not limited to:
Persistent or severe chest pain
Severe shortness of breath
Syncope or recurrent near syncope
Sustained symptomatic bradycardia or tachycardia
Stroke-like symptoms
Severe hypotension
Altered mental status
Any condition the nurse believes requires immediate emergency evaluation
Patient safety should never be delayed while awaiting provider response.
The provider must be notified as soon as possible regarding the patient’s symptoms, nursing assessment, and the disposition provided.
Step 5: Documentation
The nurse is responsible for documenting:
The patient’s reported symptoms
Pertinent assessment findings
Time the provider was notified
Provider recommendations
Instructions provided to the patient
Patient disposition (office appointment, emergency department, instructed to call 911, urgent office evaluation, home care, etc.)
Any additional follow-up performed
Staff Expectations
Front office staff are expected to promptly communicate all cardiac symptom calls to the nursing staff and should never provide medical advice or independently determine the appropriate level of care.
Licensed nursing staff are responsible for assessing symptoms, consulting the provider whenever possible, documenting all patient interactions, and ensuring patients receive appropriate and timely care.
Why This Policy Matters
Telephone triage plays a critical role in identifying potentially life-threatening cardiac conditions. A standardized workflow ensures patients receive prompt clinical assessment, appropriate provider involvement, and timely emergency intervention when necessary. Clearly defined responsibilities improve communication, reduce delays in care, and promote the highest standard of patient safety.