Telehealth Safety & Reporting Guidelines SOP

With telehealth, you’re seeing patients outside of the safety and control of a physical location. An emergency (life threatening) situation may arise from a wide range of causes, including a mental health crisis, stroke/heart attack, overdose, etc.

The following describes the most common patient emergency scenarios. Use clinical judgment if you detect there may be an emergency outside of these examples.

• When there is an immediate threat to a patient's safety in session or outside session.

• When an RD suspects possible abuse or other harm to a patient.

• When a patient is medically compromised and requires immediate medical attention.

• If a patient is at imminent risk of self harm in session or outside session.

This includes but is not limited to the following:

• Chest pain or tightness

• Breathing difficulties

• Uncontrollable bleeding

• Severe burns

• Poisoning

• Unconsciousness or seizures

• Numbness or paralysis

• A life-threatening injury or condition

• Unresponsive

• Suicidal ideation

During the first session:

Answer the following questions with your patient before or during the first appointment.

• Verify that the emergency contact info in their patient profile is correct

• Check their profile for physical location

• If an urgent situation occurs during a session that involves safety concerns for patients, the following steps should be followed:

  • Use the chat feature in the Help Center to urgently contact support with all the necessary information (e.g. “I have a patient who appears to be in distress. I am currently still on with the patient”).

  • If necessary, encourage the patient to call 911 on their own as this will connect them with their local emergency dispatch.  

    • If the patient is unable or unwilling to call 911, contact the non-emergency police number for the patient’s local area.  Calling 911 from your personal device will connect you with your local emergency dispatch. 

  • In a mental health crisis:

    • If a patient reports suicidal ideation with intent or plan:

      • Refer them to the Suicide and Crisis Lifeline (988) or alternative crisis resource.

      • If the patient has an emergency contact listed, initiate contact to alert of the present situation and current interventions.  When someone’s life is in imminent danger, confidentiality may be breached.  

      • If the patient has completed an ROI for their multidisciplinary team, initiate contact with the provider(s) for coordination of care.  

    • If a patient reports suicidal ideation without intent or plan:

      • Recommend them to initiate contact with a mental health professional on their multidisciplinary team (e.g., therapist, psychiatrist, etc.) for additional support.

      • Ensure the patient has access to and knows how to utilize crisis resources.

      • If the patient has completed an ROI for their multidisciplinary team, alert them that you will initiate contact with the provider(s) for coordination of care.  

  • Stay on the Zoom call with the patient if possible until a resolution has occurred (e.g. EMT arrives, crisis is de-escalated).

  • Document in the chart note the details of the emergency and how it was managed by Nourish with time stamps (i.e. the patient seemed SOB 15 minutes into our session at 10:15 [time zone]. RD suggested they call 911 and the patient stayed on Zoom while contacting 911. RD stayed with the patient on Zoom until first responders arrived. RD disconnected the call once the patient was in the care of first responders at 10:42ET. Will follow-up with patient by message and email on [date]). 

After the appointment is complete and immediate crisis has been managed:

• Send email to support@usenourish.com and clinicalquality@usenourish.com to explain the situation and make the clinical team fully aware of any potential calls/emails they may receive. 

• Follow up with the patient as appropriate and ensure documentation is updated to close the loop.

• If a patient alerts by message or email of an urgent situation that involves a safety concern:

  • Encourage the patient to seek immediate medical attention by contacting their PCP, visiting urgent care or the emergency room, or calling 911 if warranted. 

  • In a mental health crisis:

    • If a patient reports suicidal ideation with intent or plan:

      • Refer them to the Suicide and Crisis Lifeline (988) or alternative crisis resource.

      • If the patient has an emergency contact listed, initiate contact to alert of the present situation and current interventions.  When someone’s life is in imminent danger, confidentiality may be breached.  

      • If a patient has completed an ROI for their multidisciplinary team, initiate contact to alert of the present situation and current interventions.

    • If a patient reports suicidal ideation without intent or plan:

      • Recommend them to initiate contact with a mental health professional on their multidisciplinary team (e.g., therapist, psychiatrist, etc.) for additional support.

      • Ensure the patient has access to and knows how to utilize crisis resources.

      • If the patient has completed an ROI for their multidisciplinary team, alert them that you will initiate contact with the provider(s) for coordination of care. 

• Copy the verbiage of the message, or forward the email to a CQM at clinicalquality@usenourish.com

• Close the loop (i.e. manager has been notified and responded) and document in the notepad in the patient's chart.  

Escalation of Urgent, Non-Life Threatening scenarios: 

Nourish RDs may be made aware of non-life threatening but serious conditions. For example:

• A patient is rapidly losing weight or says they are refusing intake.

• A minor patient is reporting non-life-threatening abuse.

• A patient reports or you detect an acute change in mood (i.e. extremely sad, anxious, or irritable). 

In these cases, the RD should:

• Review Emergent Care Coordination SOP.

• Contact a CQM at clinicalquality@usenourish.com to review the details and determine the best next steps.

• Document the conversation in the chart note with day and time. 

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Mandatory reporting is a legal requirement under state law that certain professionals, including healthcare providers, must report suspected abuse or neglect of vulnerable populations to designated authorities. Reporting is required when there is reasonable suspicion - proof or confirmation is not needed.

For telehealth services, the reporting obligation is based on the patient’s physical location at the time of the visit, not the provider’s location.

Mandatory reporting laws vary by state. Differences may include:

• Who is considered a mandated reporter

• What types of abuse or neglect must be reported

• Reporting timeframes and methods

• Which agency receives the report

Reminder: The individual experiencing abuse does not need to be your patient (e.g., a patient discloses abuse of someone they know). Reporting requirements may vary by state; some apply when information is learned in a professional capacity, while others require reporting regardless of how the information is obtained.

Registered Dietitians are expected to comply with relevant mandatory reporting laws. Refer to the resources below for guidance and state-specific information. 

Most states require reporting of suspected abuse or neglect involving:

1. Children

• Physical, sexual, or emotional abuse

• Neglect or exploitation

2. Older Adults (Elder Abuse)

• Physical or emotional abuse

• Neglect or self-neglect

• Financial exploitation

3. Dependent or Vulnerable Adults

• Abuse or neglect of adults with disabilities or conditions limiting self-care

Some states also require reporting of:

• Certain domestic violence situations

• Serious injuries caused by weapons
  

• Reports must be made when there is reasonable suspicion, not only certainty

• Many states require reporting within a specific timeframe (often 24 hours)

• Reports are typically made to:

  • Child Protective Services (CPS)

  • Adult Protective Services (APS)

  • State reporting hotlines or law enforcement

RDs are not responsible for investigating — only for reporting concerns.

• Reports made in good faith are generally protected from liability

• Failure to report when required may result in legal penalties and professional discipline
  

Use the following trusted resources to identify mandatory reporting requirements and reporting contacts based on the patient’s state of location:

• Child Welfare Information Gateway Provides state-by-state summaries of mandatory reporting laws for child abuse and neglect, including who must report, what must be reported, and links to state statutes and reporting agencies.

• Eversafe Nationwide Reporting Chart An interactive chart with state-specific reporting contacts for elder and vulnerable adult abuse, including Adult Protective Services and emergency resources.
  

• Protects patients by ensuring accurate reporting

• Protects you legally — clear documentation supports good-faith reporting

• Supports compliance with state and federal laws

• If the abuse is reported or observed during a session, please document details in the intervention details of your note as care coordination 

• If the abuse is reported observed between sessions, please document in the addendum of the chart note

When you suspect abuse or neglect, your documentation should include: 

Patient Information: 

• Name, age, location, address, relevant identifying details

Observations & Concerns: 

• Objective facts (what you heard, saw, or the patient reported)

• Avoid assumptions or judgements

• Include dates, times, locations

Actions Taken:

• Date and time the report was made

• Agency or hotline contacted (CPS, APS, police, etc.)

• Any advice or instructions given by the agency

Communication with others: 

• Notes on conversations with caregivers or other professionals (if applicable)

• Use objective language: “Patient reported…” instead of “Patient is being abused.”

• Be thorough but concise: Include relevant details without speculation.

• Keep it confidential: Documentation goes in the secure patient record, separate from casual notes.

• Document promptly: Record observations and actions as soon as possible, ideally the same day.