Taking a call

Ask the phone questions from the on-call checklist, then put the call in one of four boxes.

• Go now → threatened airway, falling SpO₂, new confusion or drop in GCS, seizure, chest pain, active bleeding, SBP below 90, a critical lab result, NEWS2 7 or more, or a nurse who is very worried. Tell the senior on the way; peri-arrest: arrest team.
• Next → NEWS2 5 to 6, or a single parameter scoring 3, or a new symptom with normal vitals. Before any routine job.
• Phone only → no new clinical decision is needed (below).
• Treating team → ask “what happens if this waits until the morning?” Nothing: say so, and put it on the handover list.

The score never overrides worry. A nurse who says “I just don’t like how he looks” gets a “go now”.

• Fine by phone → re-charting a drug already planned, a result you were expecting and that changes nothing, a question the chart answers.
• Never by phone → a new symptom, a new abnormal vital sign, a new drug for a new problem. See the patient first.
• Not sure what they want → ask: “what are you asking me to do?” Clarify before you agree.

• Sickest first → by the boxes above, not by the order they rang.
• Tell the waiting nurse → when you will come, and “call me back if anything changes”.
• Two “go now” at once → senior now. You cannot be in two places.

The checklist lists when. Add these:

• You are about to do something new → a drug or procedure you have not done before.
• Not better after your first measures → or the nurse is still worried.
• Refusing or wants to leave → refusal and leaving against advice.
• How → SBAR in one breath: situation, background, your assessment, what you want from them.

• Tell the nurse → the plan, what to watch, a number to call back on (“SBP under 90, call me”).
• Read back → any instruction given by phone; they say it back, you confirm.
• Write it → on-call note, timed.
• Your list → patient, problem, review time; tick it when done.
• Not done by the end → it goes to handover.

Reviewed October 2026 against the Royal College of Physicians National Early Warning Score 2 (2017), the Institute for Healthcare Improvement SBAR toolkit, and AHRQ TeamSTEPPS (call-out and check-back).