“I’m going to the loo ten times a day with blood — can you just call something in?”

A UC flare is SCORED, not eyeballed, and telephone triage must quantify it precisely: stool frequency, amount of blood, NOCTURNAL stools (a marker of active disease), urgency, abdominal pain and systemic upset. The Truelove & Witts criteria define ACUTE SEVERE ulcerative colitis — ≥6 bloody stools per day PLUS at least one systemic feature (temperature >37.8°C, pulse >90, haemoglobin <105 g/L, or raised CRP/ESR). A patient with ~10 bloody stools/day, nocturnal symptoms, fever and exhaustion meets these criteria, and acute severe UC is a medical EMERGENCY (toxic megacolon, perforation, VTE risk) demanding SAME-DAY assessment/admission for IV steroids, bloods (FBC, CRP, U&E, albumin), stool culture including C. difficile, and gastroenterology — NOT a telephone prescription of oral steroids, which would be a serious safety failure. Screen in-flare red flags (severe pain/distension, high fever, dehydration/shock, vomiting, tachycardia) and counsel on VTE risk, but do not downgrade an acute-severe flare that lacks them. Telephone triage’s job is accurate severity assessment, danger-sign screening, clear safety-netting and correct disposition via the acute/IBD pathway. Long-standing extensive colitis warrants colonoscopic CRC surveillance — worth confirming as a future-care point, but it is not a reason for an urgent cancer referral during an acute flare. NICE CG118 starts surveillance 10 years after symptom onset (BSG 2019: 8 years). The hidden agenda is real work/childcare pressure and hospital avoidance with minimisation; validate it, problem-solve the barriers, be honest the flare is too severe for a phone fix, and bring her safely to same-day care.