ASF Standards · Telemedicine · Standard 4
Standard 4 — Emergency Escalation for the Remote Patient
Criteria in this standard
4.1 — Patient Location Is Confirmed at the Start of Every Session
4.2 — A Specific, Tiered Emergency Activation Protocol Exists
4.3 — The Provider Remains Connected Until Emergency Services Have Genuinely Taken Over Care
4.4 — Emergency Contacts Are Genuinely Verified as Aware and Willing
4.5 — A Specific Threshold Exists for When Telehealth Is No Longer Clinically Appropriate
4.2 — A Specific, Tiered Emergency Activation Protocol Exists
4.3 — The Provider Remains Connected Until Emergency Services Have Genuinely Taken Over Care
4.4 — Emergency Contacts Are Genuinely Verified as Aware and Willing
4.5 — A Specific Threshold Exists for When Telehealth Is No Longer Clinically Appropriate
4.1
Patient Location Is Confirmed at the Start of Every Session
Non-Negotiable
The patient's actual, current location is genuinely confirmed at the start of every single session — not assumed from an intake record or a prior visit, given that a patient's real location on any given day can genuinely differ from what's on file, and this is exactly the information an emergency response would need most.
In plain terms: At the start of every session — not just the first — the provider confirms exactly where the patient is, so emergency services can be sent to the right address if needed.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Full | Full | Full | Full |
Why this matters
This overlaps with 2.2 but the purpose is different: 2.2 is about licensure; this is about saving a life. If the patient collapses, has a seizure, or discloses an imminent suicide plan, the provider must be able to tell emergency services where to go — the street address, the flat number, the door code. 'At home' is not an address. The confirmation must happen every session, because patients travel, and it must be specific enough to dispatch an ambulance. It takes ten seconds and is the difference between help arriving and not.
What good looks like
- Actual, current location is genuinely confirmed at the start of every session.
- Confirmation is specific enough to genuinely guide an emergency response.
- A location change from what's on file triggers genuine documentation and awareness.
Common failure modes
- Location is assumed from intake or a prior visit, not confirmed each session.
- Confirmation is vague, insufficient for genuine emergency dispatch.
- A location change goes unnoticed or undocumented.
Worked example
In practice
A telemedicine mental health service.
BeforeLocation was confirmed at intake only. During a session, a patient took an overdose on camera. The provider called emergency services but could only give the address on file — the patient had moved. The ambulance went to the wrong city. The patient survived by chance.
ActionEvery session now begins with: 'Can you confirm your full address right now, including any flat number or entry code?' The answer is recorded in the session note. Patients are told why. If a patient refuses or cannot give a location, the session does not proceed for clinical content. The emergency protocol (4.2) uses this address.
AfterThe Monitor reviewed 50 session notes: all with session-specific address confirmed. Observed a session opening. Verified.
If you are starting from zero — do this first
- Make address confirmation the first line of every session note.
- Script it: full address, flat number, entry code.
- Tell patients why you ask every time.
- Do not proceed without it.
The most common mistake: Confirming location once at intake — the emergency happens on the day they are somewhere else.
Self-assessment questions
1. Is the patient's actual, current location genuinely confirmed at the start of every single session? — Real, active confirmation every session, not assumed from intake or a prior visit.
Evidence: Session-start location confirmation record
Evidence: Session-start location confirmation record
2. Is this confirmation specific enough to guide an actual emergency response — not just a general city or region? — Real, specific detail sufficient for genuine emergency dispatch, not a vague general area.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
3. Does a location differing from what's on file trigger any specific, genuine documentation or awareness? — Real, active awareness of a location change, not silently overwritten or ignored.
Evidence: Location change documentation
Evidence: Location change documentation
Common reasons for a PARTIAL answer
- Confirmation happens reliably for new patients but lapses into assumption for established, long-term patients. — An established patient's actual location can change just as genuinely as a new patient's, and deserves the same confirmation.
- Confirmation is verbal but not specifically documented in a way that's genuinely retrievable during an actual emergency. — Documentation that's difficult to retrieve quickly doesn't provide real, usable protection in an actual crisis.
- Confirmation happens for scheduled visits but is inconsistent for urgent or same-day sessions.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current location confirmation practice for genuine consistency across all patients and session types. |
| Week 2 | Establish a specific, mandatory location confirmation step at the start of every session. |
| Week 3 | Build genuine documentation practice for location changes from what's on file. |
| Ongoing | Audit confirmation consistency across established and new patients alike. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| OBSERVE | Session-start confirmation observation | Observes an actual session opening for genuine, specific location confirmation. |
| DOCUMENT | Confirmation specificity review | Reviews documented location confirmations for genuine, actionable specificity. |
| DOCUMENT | Location change awareness review | Reviews whether a location differing from file triggers genuine documentation. |
Supervisor tips
- Observe an actual session opening to confirm location is genuinely, specifically confirmed. — Direct observation reveals genuine practice, not an assumption from stated policy.
- Ask a long-term patient whether they're asked to confirm their location at the start of each session. — This tests whether the practice genuinely extends to established patients, not just new ones.
Evidence base
[16] Genuine confirmation of a client's physical location at the start of every single session, not reliance on intake records, is established as essential telehealth crisis protocol, because not knowing where a patient actually is can be the difference between emergency help arriving and not arriving.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
4.2
A Specific, Tiered Emergency Activation Protocol Exists
Non-Negotiable
A specific, tiered protocol exists for activating emergency services — direct local activation where covered, a patient-reported local dispatch number where standard coverage doesn't reach, and a relay mechanism connecting the provider to local emergency services as a further alternative — not a single, undifferentiated assumption that dialing a standard emergency number will always work regardless of the patient's actual location.
In plain terms: There is a written, tiered emergency protocol — direct local emergency dispatch where the service covers it, a named alternative where it does not — and providers know it cold.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Full | Full | Full | Full |
Why this matters
A telemedicine provider in one country cannot call the emergency number in another and expect it to work. Even within a country, emergency services are dispatched locally and a remote provider may not reach the right centre. A tiered protocol addresses this: for each jurisdiction the service covers, the direct emergency number and how to reach the local dispatch; where direct activation is not possible, a named alternative (a local partner, a patient's emergency contact, a third-party service); the provider's role during activation (stay on, give the address, relay information); and documentation. Providers must know the protocol without looking it up.
What good looks like
- A specific, tiered protocol genuinely exists for varying location scenarios.
- Providers are genuinely trained on all tiers, not just the most common method.
- The protocol has genuinely been tested, not only described in policy.
Common failure modes
- Only a single emergency activation method is known, assumed to work everywhere.
- Training covers only the most common, direct activation method.
- The protocol exists only in writing, never tested or rehearsed.
Worked example
In practice
A telemedicine service covering patients in three countries.
BeforeThe emergency protocol said 'call emergency services.' Providers in one country did not know the emergency numbers in the other two, or that calling from abroad might not reach local dispatch. A patient's cardiac event during a cross-border session resulted in a 15-minute delay while the provider searched for the right number.
ActionA tiered protocol was written per jurisdiction: local emergency number; how a remote provider reaches local dispatch (direct dial where possible, via the patient's own phone where not, via a contracted emergency coordination service for cross-border cases); the provider's script; the patient's emergency contact as a parallel channel; documentation. Laminated cards per jurisdiction are at every provider's workstation. Quarterly drills use scenarios.
AfterThe Monitor reviewed the protocol, the jurisdiction cards, the emergency coordination contract, and three drill records. Asked two providers to describe the protocol for a specific country; both did. Verified.
If you are starting from zero — do this first
- List every jurisdiction where you have patients. For each, what is the emergency number and can you reach local dispatch from where you are?
- Write a tiered protocol per jurisdiction.
- Put a card at every workstation.
- Drill quarterly.
The most common mistake: A protocol that says 'call emergency services' — from another country, that may not work.
Self-assessment questions
1. Does a specific, tiered protocol exist for activating emergency services across different location scenarios? — A real, multi-tiered protocol, not a single method assumed to work everywhere.
Evidence: Tiered emergency activation protocol documentation
Evidence: Tiered emergency activation protocol documentation
2. Are providers genuinely trained on all tiers of this protocol, not only the most common, direct method? — Real, complete training across every tier, not familiarity with the simplest scenario alone.
Evidence: Provider protocol training record
Evidence: Provider protocol training record
3. Has this protocol genuinely been tested or rehearsed, not only described in written policy? — Real, tested practice, not a protocol that exists only on paper.
Evidence: Protocol testing record
Evidence: Protocol testing record
Common reasons for a PARTIAL answer
- Providers know the direct activation method well but are less confident with the relay center alternative. — Every tier deserves the same genuine provider confidence, since any tier might be the one actually needed.
- The protocol is documented but hasn't been updated to reflect current relay center contact information. — An outdated contact detail can undermine the entire protocol's genuine, real functionality when actually needed.
- The protocol has been reviewed internally but never tested through an actual simulated emergency scenario.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current emergency activation knowledge for genuine coverage of all protocol tiers. |
| Week 2 | Establish or update the specific, tiered protocol with current contact information. |
| Week 3 | Train all providers on every tier, not the most common scenario alone. |
| Ongoing | Test the protocol periodically through simulated emergency scenarios. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Protocol documentation review | Reviews the actual, specific, tiered emergency activation protocol. |
| DOCUMENT | Training completeness review | Reviews training records for genuine coverage of all protocol tiers, not the simplest scenario alone. |
| DOCUMENT | Testing record review | Reviews evidence the protocol has genuinely been tested or rehearsed. |
Supervisor tips
- Ask a provider to walk through all three tiers of the emergency activation protocol, not just the simplest one. — A specific, complete answer reveals genuine, full training, not familiarity with one method alone.
- Ask when the protocol was last genuinely tested through a simulated scenario. — A specific, real answer reveals genuine practice, not a protocol that exists only on paper.
Evidence base
[17] A documented telehealth emergency management protocol establishes a three-tiered emergency activation process: direct local emergency service activation where standard coverage exists, a patient-reported local dispatch number where it doesn't, and an e911 relay center connecting the clinician to local emergency services as a further alternative.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
4.3
The Provider Remains Connected Until Emergency Services Have Genuinely Taken Over Care
Non-Negotiable
When emergency services are activated during a session, the provider genuinely stays connected with the patient until local emergency responders have arrived and care has actually been transferred — not disconnecting once the call for help has been made, leaving the patient alone in the interval before help physically arrives.
In plain terms: When emergency services are called during a session, the provider stays on the line with the patient until responders have actually arrived and taken over — not until the ambulance is dispatched.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Full | Full | Full | Full |
Why this matters
The provider calls the ambulance and ends the session. The patient, alone, deteriorates in the twenty minutes before the ambulance arrives — or the ambulance cannot find the door, or the patient panics and does not answer. Staying connected means: keeping the patient on video or phone, talking to them, monitoring their condition, guiding them (unlock the door, lie down, do not take anything), relaying updates to dispatch if possible, and confirming that responders have arrived and are with the patient. Only then does the provider disconnect and document. The provider's next appointment waits.
What good looks like
- Providers genuinely remain connected until emergency responders have actually arrived.
- Care is genuinely, actively transferred to responders, not a passive disconnection.
- This expectation is specifically, clearly trained, not left to individual judgment.
Common failure modes
- Providers disconnect once the emergency call is made, before responders arrive.
- The session ends without any genuine, active handoff to responders.
- No specific training establishes this expectation.
Worked example
In practice
A telemedicine service whose emergency protocol ended at dispatch.
BeforeProviders called emergency services and ended the session to 'let them work.' A patient with an allergic reaction was left alone; she became unresponsive before the ambulance arrived and the responders could not enter the locked flat. She was found by a neighbour.
ActionThe emergency protocol was amended: the provider remains connected throughout, with a script (reassure, instruct, unlock the door, stay in view of the camera, do not hang up); another staff member handles dispatch communication and reschedules the provider's next patient; the provider confirms responders have arrived and are with the patient before disconnecting; the full timeline is documented. Providers drilled the scenario.
AfterThe Monitor reviewed the amended protocol, two real emergency activations with documented connection until handover, and drill records. Verified.
If you are starting from zero — do this first
- Read your emergency protocol. Where does the provider's role end?
- Amend it: stay connected until responders are with the patient.
- Assign another staff member to handle dispatch and rescheduling.
- Drill it.
The most common mistake: Ending the session to 'let the ambulance handle it' — the twenty minutes before arrival are when the patient is most alone.
Self-assessment questions
1. Does the provider genuinely remain connected with the patient until emergency responders have actually arrived? — Real, continuous connection through the full interval, not disconnecting once the call is made.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
2. Is care genuinely, actively transferred to responders, not simply the session ending once they're present? — Real, active handoff of relevant information to responders, not a passive disconnection.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
3. Is this expectation specifically, clearly trained, not left to individual provider judgment in the moment? — Real, specific training on this expectation, not assumed instinctive behavior under crisis pressure.
Evidence: Provider training on remaining connected
Evidence: Provider training on remaining connected
Common reasons for a PARTIAL answer
- The expectation is generally understood but the specific point of appropriate disconnection isn't clearly defined. — A specific, clear definition of when handoff has genuinely occurred provides more reliable guidance than general understanding alone.
- Training addresses this for adult patients but hasn't specifically been extended to pediatric or otherwise vulnerable patient scenarios. — Every patient population deserves the same genuine commitment to remaining connected through handoff.
- Providers report they would remain connected but this hasn't been specifically confirmed through a real or simulated event.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current provider understanding of remaining connected through emergency handoff. |
| Week 2 | Establish specific, clear training on this expectation, including the defined point of appropriate disconnection. |
| Week 3 | Extend training to cover the full range of relevant patient populations. |
| Ongoing | Confirm this practice through review of real events or simulated scenarios. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| ASK | Provider practice interview | Asks a provider to describe what they would do, and when they would disconnect, during an actual emergency activation. |
| DOCUMENT | Training review | Reviews training records confirming providers are specifically trained to remain connected through handoff. |
| DOCUMENT | Real event review | Reviews documentation from a genuine past emergency event, where available, for evidence of continued connection through handoff. |
Supervisor tips
- Ask a provider directly when they would consider it appropriate to disconnect during an emergency activation. — A specific, confident answer reveals genuine, trained understanding, not an assumption of instinctive good judgment.
- Review documentation from a real past emergency event, where one exists, for evidence of continued connection. — A real, documented example reveals genuine practice, not a stated intention.
Evidence base
[18] Established telehealth emergency management protocol specifically requires clinicians to remain connected on the session with the patient until local emergency services arrive on scene and care is genuinely transferred, only disconnecting once that handoff has actually occurred.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
4.4
Emergency Contacts Are Genuinely Verified as Aware and Willing
Non-Negotiable
A patient's designated emergency contact is genuinely verified as aware of and willing to serve in that role — not simply a name and number listed on an intake form without any actual confirmation that this person knows they've been named or agrees to it.
In plain terms: The patient's emergency contact has been asked and has agreed to be one — and knows what it means — not just a name written on the intake form.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Full | Full | Full | Full |
Why this matters
The emergency contact is who the provider calls when the patient cannot be reached or is in crisis — to check on them, to open the door for responders, to be with them. If the named person does not know they are the emergency contact, does not live nearby, has not spoken to the patient in a year, or would refuse, the channel is fictional. Verification means the service contacts the named person once, confirms they are aware, willing, and able (proximity, availability), and records it. It is done at intake and re-checked annually. An unverified emergency contact is a name on a form.
What good looks like
- Emergency contacts are genuinely verified as aware and willing to serve.
- Both a primary and secondary contact are designated and genuinely verified.
- Verification is periodically reconfirmed, not assumed to remain accurate indefinitely.
Common failure modes
- Contacts are listed without any genuine verification of awareness or willingness.
- Only a single, unconfirmed contact exists, with no verified backup.
- Verification, if it happened, was never reconfirmed and may be outdated.
Worked example
In practice
A telemedicine mental health service with emergency contacts recorded but never verified.
BeforeEmergency contacts were written on intake forms. During a crisis, the provider called the contact — the patient's estranged brother in another country, who had not been told and said 'I can't help.' Another contact number was disconnected.
ActionAt intake, the service now contacts each emergency contact by phone: confirms they are aware and willing, lives within reasonable reach, and understands they may be called in a crisis; records the confirmation and any limitations. Contacts are re-verified annually and whenever the patient updates the information. Patients without a viable contact are helped to identify one, or a local service is arranged as an alternative.
AfterThe Monitor reviewed 30 patient files with verified emergency contacts and dates; two showed a contact replaced after verification revealed unwillingness. Verified.
If you are starting from zero — do this first
- Phone ten emergency contacts from your files. How many know they are one?
- Verify every contact at intake — aware, willing, nearby.
- Record the verification.
- Re-verify annually.
The most common mistake: Accepting a name and number without ever calling it.
Self-assessment questions
1. Is the designated emergency contact genuinely verified as aware of and willing to serve in that role? — Real, active verification, not a name listed without actual confirmation.
Evidence: Emergency contact verification record
Evidence: Emergency contact verification record
2. Does the patient have both a primary and secondary emergency contact, each genuinely verified? — Real, verified coverage for both a primary and a genuine backup, not reliance on a single, unconfirmed contact.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
3. Is verification genuinely reconfirmed periodically, not assumed to remain accurate indefinitely? — Real, periodic reconfirmation, not a one-time check assumed valid forever.
Evidence: Periodic reconfirmation record
Evidence: Periodic reconfirmation record
Common reasons for a PARTIAL answer
- Primary contacts are genuinely verified but secondary contacts are recorded without the same active confirmation. — A secondary contact carries the same real, genuine importance as a backup, deserving the same verification.
- Verification happened at intake but hasn't been reconfirmed even as significant time has passed. — A relationship or willingness can genuinely change over time, and periodic reconfirmation reflects this reality.
- Verification is documented as complete but the actual method of confirmation isn't specifically recorded.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current emergency contact designation for genuine verification versus unconfirmed listing. |
| Week 2 | Establish a specific, active verification process for both primary and secondary contacts. |
| Week 3 | Build a periodic reconfirmation schedule. |
| Ongoing | Audit emergency contact verification for continued accuracy. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Verification record review | Reviews evidence of genuine verification that emergency contacts are aware and willing. |
| DOCUMENT | Primary and secondary coverage review | Reviews whether both a primary and secondary contact are genuinely designated and verified. |
| DOCUMENT | Reconfirmation schedule review | Reviews whether verification is periodically reconfirmed, not treated as permanently valid. |
Supervisor tips
- Ask to see the specific documentation of how a real emergency contact's willingness was actually confirmed. — A real, specific record reveals genuine verification, not an assumption based on a listed name.
- Ask when emergency contact verification was last reconfirmed for a long-term patient. — A specific, real answer reveals genuine, ongoing practice, not a one-time check.
Evidence base
[19] Genuine designation of primary and secondary emergency contacts requires a verification step confirming the contact has been informed and is willing to serve in that role, distinct from a name and number recorded without active confirmation.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
4.5
A Specific Threshold Exists for When Telehealth Is No Longer Clinically Appropriate
Core
A specific, defined threshold exists for recognizing when telehealth is no longer clinically appropriate for a given patient's situation and a higher level of care must be facilitated — not continuing remote sessions indefinitely because no clear point was ever established for when this shift should genuinely occur.
In plain terms: The service has written criteria for when a patient is no longer suitable for remote care — deteriorating mental state, escalating risk, needs the platform cannot meet — and acts on them.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | N/A | Full | Adapted | Full |
Why this matters
Telemedicine works for many patients most of the time. It stops working when a patient's condition needs what remote care cannot provide: frequent in-person monitoring, a physical examination, a safe environment, crisis intervention. A patient with worsening psychosis, a patient whose suicide risk has escalated, a patient whose home has become unsafe — each has crossed a threshold. The threshold must be defined in advance, so the decision is not left to the moment: specific indicators, a required review, a transition plan to appropriate care. A service without a threshold keeps patients remote past the point of safety.
What good looks like
- A specific, defined threshold genuinely exists for this determination.
- Providers are specifically trained to recognize this threshold, not relying on individual instinct alone.
- A genuine, defined process facilitates a higher level of care once the threshold is reached.
Common failure modes
- No specific threshold exists; the determination is left to undefined, case-by-case judgment.
- Providers aren't specifically trained; recognition depends on individual instinct.
- The threshold, if recognized, doesn't lead to any defined facilitation process.
Worked example
In practice
A telemedicine psychiatric service.
BeforePatients remained in remote care indefinitely regardless of deterioration. A patient with escalating psychosis was seen remotely for six weeks after he stopped taking medication, until a family member took him to hospital. No criteria existed for when remote care should end.
ActionA telehealth appropriateness threshold was written: indicators requiring transition (active suicidal ideation with plan, psychosis with loss of insight, substance intoxication at sessions, inability to maintain a safe environment, need for physical examination or monitoring, non-response to remote treatment over a defined period); a required review at each session against the indicators; a transition plan when triggered — referral to in-person services with warm handover, bridging care, and documented rationale. Providers were trained.
AfterThe Monitor reviewed the threshold criteria, session templates with the indicator check, and 6 transitions in six months with documented rationale and handover. Verified.
If you are starting from zero — do this first
- Ask providers: when should a patient stop being seen remotely? Write down the answers.
- Define the indicators in the clinical protocol.
- Add an indicator check to every session.
- Write the transition process.
The most common mistake: Keeping a deteriorating patient on the platform because the platform is what you have.
Self-assessment questions
1. Does a specific, defined threshold exist for recognizing when telehealth is no longer clinically appropriate? — A real, specific threshold, not an undefined, case-by-case judgment made in the moment.
Evidence: Level-of-care threshold documentation
Evidence: Level-of-care threshold documentation
2. Are providers genuinely trained to recognize this threshold, not left to develop their own individual sense of it? — Real, specific training on the defined threshold, not assumed clinical instinct alone.
Evidence: Provider threshold training record
Evidence: Provider threshold training record
3. When this threshold is reached, is there a genuine, defined process for facilitating a higher level of care? — A real, specific facilitation process, not the threshold being recognized without a clear next step.
Evidence: Higher-level-of-care facilitation process
Evidence: Higher-level-of-care facilitation process
Common reasons for a PARTIAL answer
- A general principle is understood but the specific, defined threshold criteria aren't documented. — Documented, specific criteria provide more consistent, reliable recognition than general principle alone.
- The threshold is well understood for acute crisis situations but less clearly defined for gradually deteriorating ones. — Gradual deterioration deserves the same genuine, defined threshold as acute presentations, since drift can be harder to notice.
- A facilitation process exists but doesn't specify a genuine, named pathway to the actual higher level of care.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current practice for a genuine, defined threshold versus undefined case-by-case judgment. |
| Week 2 | Establish specific, documented threshold criteria, including for gradual deterioration. |
| Week 3 | Train providers on recognizing this threshold and the defined facilitation process. |
| Ongoing | Review threshold application against real, recent cases for consistency. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Threshold documentation review | Reviews the specific, defined threshold for when telehealth is no longer clinically appropriate. |
| DOCUMENT | Training review | Reviews training records confirming providers are specifically trained to recognize this threshold. |
| DOCUMENT | Facilitation process review | Reviews the defined process for facilitating a higher level of care once the threshold is reached. |
Supervisor tips
- Ask a provider to describe the specific criteria that would tell them telehealth is no longer appropriate for a patient. — A specific, confident answer reveals genuine, defined understanding, not undefined individual judgment.
- Ask for a real, recent example of a patient transitioned to a higher level of care and what specifically prompted it. — A real, traceable example reveals whether this threshold genuinely functions in practice.
Evidence base
[20] Established telehealth crisis protocol specifically addresses when telehealth is no longer clinically appropriate and a higher level of care needs to be facilitated, establishing a defined threshold as necessary practice, distinct from indefinite continuation of remote sessions without a clear transition point.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.