Emergency symptoms and serious deterioration

Some contacts require immediate action and should interrupt routine booking, call-back and online-request workflows. Patients may describe a contact as routine, but the words they use can indicate the need for urgent clinical attention.

Respond to what the patient says, not to the category they chose. A "routine" label does not make chest pain, collapse, stroke symptoms, severe breathlessness or other serious deterioration safe to wait.

Listen or look for

• Chest pain, severe breathlessness, collapse or stroke symptoms
• New confusion, severe weakness, drowsiness or not making sense
• Severe pain, sudden deterioration, blue lips, mottled skin or heavy bleeding
• Suicidal thoughts, inability to stay safe, overdose or threats to others
• Babies, children, pregnant or recently pregnant patients with urgent warning words

Preserve the urgent wording

Do not dilute serious wording into neutral admin language. Record the patient's phrase exactly - "chest pain and sweating" is clearer than "chest query", and "confused and weak overnight" is clearer than "unwell". Clinicians and urgent services need the original wording to assess risk.

Changes over time are important. Words such as "worse", "suddenly", "not improving", "now breathless", "not themselves" or "cannot cope" can show increasing risk and should prompt escalation.

Digital/records detail

The patient's chosen route or category does not make urgent wording safe to wait.