Arrival Day Protocol — International Patients
Dr Chetan Kalal | International Patient Concierge
Purpose
A concise, step-by-step protocol for the arrival day of international patients seeking hepatology or liver transplant evaluation under Dr Chetan Kalal. Designed to ensure clinical safety, efficient workflow, legal/administrative completeness, and high-touch patient experience.
Scope
Applies to: international patients, NRIs, and accompanying family arriving for outpatient, inpatient, or transplant evaluations. Covers first-contact actions from airport pickup to first 24–48 hours of clinical care.
Pre-Arrival Checklist (to be completed 24–72 hours before arrival)
Confirm Appointment & Arrival Window — Concierge confirms exact hospital/clinic arrival time and point-of-contact (POC) mobile number.
Medical Records Upload — Ensure all recent reports (CT/MRI images, FibroScan, biopsy, LFTs, viral serology, discharge summaries) are uploaded via secure channel. If imaging was not uploaded, confirm that DICOM files will be brought on a USB.
Medication List — Patient sends complete medication list with dosages and recent changes; highlight anticoagulants, insulin, or immunosuppressants.
Travel Fitness Check — Clinician confirms fitness for air travel if high-risk (encephalopathy, severe ascites, active bleeding, unstable vitals).
Local Logistics — Airport pickup, accommodation arranged, local SIM and emergency contact details shared.
Consent & Forms — Send preliminary consent forms, privacy notices, and payment pre-authorisation documents for pre-signing if applicable.
Arrival Day — Step-by-Step Protocol
Goal: Rapid clinical triage, stabilization (if required), administrative completion, and clear clinical roadmap for next 48 hours.
1. Airport Pickup & Transfer
Concierge or driver meets patient at pre-agreed arrival point with ID confirmation.
Short verbal handover to clinic POC via WhatsApp/phone on arrival.
If patient requires stretcher/oxygen, ambulance transfer to hospital arranged in advance.
2. Hospital/Clinic Reception (T = 0)
Concierge escorts patient to dedicated international patient reception desk.
Verify identity (passport), visa/medical visa, and emergency contact.
Collect printed copies of uploaded medical records; request original imaging media if brought.
Provide patient with a printed Arrival Day Schedule and Clinician contact number.
3. Administrative & Financial Clearance (T = 0–30 min)
Confirm appointment, collect advance deposit if applicable, and provide receipts.
Explain billing process, expected tests on arrival, and estimated first-48-hour costs range.
Present patient with hospital map, ward/room details, and visiting policies (if inpatient).
4. Clinical Triage & Initial Nursing Assessment (T = 30–60 min)
Vital signs: BP, HR, RR, temperature, SpO2, capillary blood glucose.
Weight, height, waist circumference.
Brief neurological screen (orientation, asterixis) for encephalopathy assessment.
Document current IV lines/meds and allergies.
5. Immediate Clinician Review or Rapid Stabilisation (T = 60–120 min)
If triage flags emergency (active bleeding, encephalopathy grade II+, hypotension, sepsis), escalate to on-call hepatology/ICU team immediately.
If stable, Dr Kalal or assigned consultant performs focused history & physical, reviews uploaded reports and initial vitals.
Clarify the primary reason for travel and confirm prior recommendations.
6. Essential Baseline Investigations (to be completed within first 4 hours)
Bloods: CBC, LFTs (AST, ALT, ALP, GGT), total bilirubin, direct bilirubin, INR, albumin, creatinine, electrolytes, RFT, glucose, ammonia (if encephalopathy suspected), blood cultures if febrile.
Viral serologies if not recent: HBsAg, anti-HCV, HBV DNA / HCV RNA as indicated.
Coagulation profile and crossmatch if any procedure planned.
Imaging: Urgent ultrasound (with portal & biliary assessment). CT/MRI as indicated (prior imaging should be available to avoid repeat).
FibroScan if not recently performed and clinically indicated.
7. Medication Reconciliation & Critical Drug Management
Verify home medications; continue essential drugs unless contra-indicated.
Anticoagulant/antiplatelet management: follow pre-defined protocol — notify interventional teams before any procedure.
Insulin/diabetes management: coordinate diet and dosing; avoid hypoglycaemia.
8. Consent, Communication & Care Plan Delivery
Provide a written provisional care plan (investigations + likely next steps) and expected timeline for decisions (e.g., transplant candidacy, admission, or safe discharge).
Obtain written informed consent for any planned interventions.
Provide copy of patient-facing “what to expect in first 48 hours.”
9. Admission vs. Outpatient Pathway Decision (by T = 6–8 hours)
Admission criteria: unstable vitals, high-grade encephalopathy, active GI bleed, sepsis, AKI/hepatorenal syndrome, ACLF criteria met, immediate transplant workup needed.
Outpatient: stable compensated cases, routine second opinion, surveillance or planned non-urgent procedures.
10. Family Meeting & Documentation
If admitted or when major decisions are anticipated, hold bedside family meeting (in-person or video) to explain diagnosis, prognosis, and next steps.
Provide written documentation including contact details for the clinical team and concierge manager.
First 48 Hours — Critical Actions & Monitoring
Regular vitals (Q4–6h) for inpatients; neurological checks for encephalopathy.
Complete test panel review and multidisciplinary team (MDT) discussion within 24 hours for complex cases.
Nutritional assessment and baseline physiotherapy/sarcopenia screening for frailty.
If transplant evaluation triggered: initiate formal pre-transplant checklist (cardio-pulmonary fitness, infectious screening, donor evaluation steps).
For patients returning home: ensure clear discharge instructions and scheduled virtual follow-up within 7–14 days.
Communication Protocols
Provide an assigned concierge contact (mobile + WhatsApp) available 24/7 for first 72 hours.
All medical recommendations provided in writing and uploaded to patient record.
Secure sharing of reports for international follow-up; encrypted transmission where possible.
Documentation & Legal Considerations
Keep copies of passport, visa, and insurance docs on file.
Ensure consent forms meet international standards and are available in English; provide interpreter support if needed.
Record of all medication changes, procedures, and MDT discussions to be shared with patient/family and local physician.
Escalation Triggers (Immediate Notification to Consultant/ICU)
Systolic BP < 90 mmHg or MAP < 60 mmHg
New onset grade II+ hepatic encephalopathy
Active GI bleeding with hemodynamic compromise
Sepsis or suspected severe infection
Rapid deterioration in renal function (Rising creatinine > 0.5 mg/dL in 24 hours)
Logistics & Practical Tips for Arrival Day
Expect processing time: allow 6–12 hours on arrival day for comprehensive evaluation if no emergency.
Carry hard copies of all imaging (on DVD/USB) and recent reports.
Keep medications accessible in carry-on luggage.
Maintain hydration and avoid alcohol.
Template Checklists (for concierge/team)
Arrival Confirmation (time, flight no, arrival gate)
Patient ID verified (passport)
Records checklist complete (imaging, labs, biopsy)
Initial vitals recorded
Baseline bloods ordered
Nursing assessment complete
Clinician review completed
Admission decision documented
Family meeting scheduled (if required)
Version & Contacts
Protocol version: 1.0 — Last updated: 2025-11-24
Concierge Contact: dr.chetankalal.com
Clinical Lead: Dr Chetan Kalal, DM Hepatology
End of Arrival Day Protocol
