Table 1.

Categorization of Alerts

Category	Description	Documentation Example
Clinical management at home	Nursing or physician led symptom education and adjusting supplemental oxygen; medication or oxygen prescription; clinical status check	Spoke with patient and spouse. His oxygen (O2) was only on 1 liter per minute (LPM) and he had not yet drained his PleurX. O2 elevated to 3LPM and .475ml drained. O2 improved to 92%. Patient wanted to lower O2 back to 1LPM. Requested that he leave it at 3LPM for an hour, then re-check his saturation level.
In-person or telehealth visit	A new visit is planned or scheduled	Spoke with registered nurse (RN) at Visiting Nurse Service (VNS) - She reports crackles to the right upper lobe, 90% blood oxygen reading, blood pressure 148/64, heart rate 99. VNS confirms patient is not in any distress. He will have a telemedicine visit with [oncologist – name redacted] today who will further assess. VNS agrees with plan and will relay to patient’s family.
Acute care referral	Clinical recommendation for a patient to seek medical attention at an urgent care center or emergency department	Called wife and patient is more short of breath today with minimal activity stating blood oxygen level is in low 80’s even with home O2. Patient was just discharged from hospital yesterday. Instructed to come back to urgent care center.
No action	Lack of response from the patient after nursing or physician communication or no change in plan undertaken based on the alert	Called to check in, spoke with patient’s sister. They advised all is stable, no change. They know to call with any concerns.
Missed	An absence of chart documentation on communication from a nurse and/or physician
Technical issue/device trouble shooting	Inaccurate reading due to user error or device malfunctioning	Call due to low O2 alert of 87%. Daughter states machine provided has never worked properly. She has 2 other pulse oximeters that read 94% on 4LPM, denies shortness of breath, and patient shows no signs of distress.