Signed instruction · Elena Riverav
Trigger · Ovidrel 250 micrograms subcutaneous, once
PDT · Oct 30
Signed by Dr. Mira Lee · 17:10 PDT
v2 · 20:30 PDT · retrieval 07:30 PSTSuperseded · kept for history
Stage 4 of 9
Trigger
When leading follicles reach maturity, the trigger injection prompts final egg maturation so retrieval can take place about 35 to 36 hours later. In the fictional daily-care story, the signed instruction is Ovidrel 250 micrograms, subcutaneous, once at 20:00 PDT on Oct 30, with retrieval on Nov 1 at 07:00 PST: 36 hours apart across the daylight-saving change.
- Elena's phone shows tonight's signed Version 3 trigger instruction: Ovidrel 250 micrograms subcutaneous, once, at 8:00 PM PDT on Oct 30.
- Opening the older 8:30 PM text link shows that Version 2 is superseded and points back to the current plan.
[ Signed change ]
One signed change, four commitments.
At 17:10 PDT Dr. Mira Lee signs version 3 of Elena's trigger instruction. The old time stays visible but retired, and every commitment that depends on it is flagged for the person who owns it.
Trigger to retrieval36h 00m
From 20:00 PDT October 30 to 07:00 PST November 1. Counted across the clock change at 02:00 on Nov 1. Every clinical decision stays with the care team.
- Patient instructionRe-prepared from version 3 for ElenaFlagged for Nora Ruiz, RN
- Procedure slotRetrieval Nov 1 · 07:30 → 07:00 PSTFlagged for Procedure desk
- AnesthesiaPre-op instructions follow the 07:00 PST retrievalFlagged for Anesthesia team
- Embryology labChange order acknowledgment pending for 07:00 PSTFlagged for Embryology
From the daily-care walkthrough.Fictional patient data
Both sides
One stage, seen from both sides
For the clinic team
What the team coordinates
OvaFlow tracks the signed trigger instruction across changes and the daylight-saving clock change, the right chart, the publication outcome, the patient's reported time, and who owns the evening callback.
- Signed amendment and what it changes across the patient instruction, OR, anesthesia and embryology lab
- Wrong-chart stop before any trigger instruction is placed or published
- Publication outcome checked against the portal's own record before any resend
- Patient-reported injection time kept as reported (20:20 PDT, received 20:22 PDT) alongside the signed 20:00 PDT order
- Evening callback handed off to on-call nursing only on explicit acceptance
Operational checks at this stage (3)
- Compute elapsed hours between trigger and retrieval across time-zone and daylight-saving transitions (such as PDT to PST).
- Block placement if the active EMR chart does not match the patient on the signed trigger amendment, and verify portal publication before any retry.
- Preserve the patient's self-reported injection time as a separate timestamped record alongside the clinician-signed order, and transfer evening callbacks only on explicit acceptance.
For you and your family
What you experience
A timed injection finishes egg maturation, so the retrieval about 36 hours later lines up.
Questions you may ask here (3)
- “Why does the exact minute of my trigger injection matter so much for my egg retrieval two mornings later?”
- “What happens if I accidentally tap an earlier text notification after my clinic moved my trigger time by 30 minutes?”
- “If I inject 15 or 20 minutes late because I was nervous mixing the syringe, should I tell the clinic right away?”
Words you may hear (4)
- Trigger shot
- A timed injection that finishes egg maturation, so the retrieval about 36 hours later lines up.
- Egg retrieval
- A short procedure, usually under sedation, to collect eggs from the ovaries.
- Daylight-saving change
- When clocks change between the trigger and the retrieval (for example from PDT to PST), the wall-clock difference and the actual elapsed time differ by an hour. Each time needs its offset, such as PDT or PST, to be counted correctly.
- Patient-reported use
- The patient's own account of when they took a medication, kept with the reported and received times.
Questions about your own treatment go to your care team. OvaFlow never gives medical advice. In an emergency, call 911.
Read the plain-language guide to IVFSee it
Walkthroughs from this stage
Recorded from an interactive design prototype. Every patient, clinician and clinic is fictional, and EMR screens are modeled reconstructions.
Prototype walkthrough · Fictional patient data
Daily care: a changed trigger, the wrong chart and an unknown outcome
A late estradiol result, a newly signed trigger time, the wrong chart caught before publishing, and a lost confirmation checked rather than blindly resent.
Daily care: the 8:20 PM report and the evening handoff
Elena says she injected at 8:20, not 8:00. Her words are kept as she said them, the signed instruction stays as signed, and the evening callback changes hands only when Alex accepts it.
Artisan: trigger approval, the wrong chart and an interrupted view
Beside a modeled Artisan view, the companion compares Dr. Priya Shah's approval with the unchanged Artisan fields, stops on Maya's open chart, and won't assume an update it didn't see.
Artisan: portal distribution, lab change order, read vs accept
Saving a trigger doesn't tell the patient or the lab. Portal distribution, the lab change order and a message that was read but not accepted are each tracked separately.
Elena's iPhone: the current instruction, an old link, an honest report
An old text link can't send Elena to a superseded injection time. Reporting a late dose is simple and honest, and urgent help is one tap away.
On-call nurse iPhone: seeing isn't accepting, declining leaves no gap
On the on-call phone, seeing a handoff isn't accepting it, declining leaves the original nurse responsible, and the physician's decision stays with the physician.
Elena's episode: one change, four commitments, recovery and freeze-all
One signed change reaches instructions, the OR, anesthesia and the lab. Later an outside emergency visit for OHSS turns a planned fresh transfer into freeze-all.
Patient and clinic, side by side
The patient's phone and the clinic's workspace side by side, so each reassuring screen shows the safeguard behind it.
Handoffs and safeguards
Where work slips, and what holds instead
These are the moments the design is built around. Each safeguard stops or holds work; the decision stays with the clinician or the lab.
Where it slips today
- A revised trigger time is published into another patient's open chart during a busy afternoon run.
- A network drop after pressing Send leaves publication status unknown and leads to a duplicate or blind resend.
- A patient taps an older text notification link and follows a superseded trigger time.
- A late injection quietly overwrites the prescribed order, or the 36-hour interval is miscounted by an hour across the daylight-saving clock change.
- A read message on an on-call phone is mistaken for an accepted evening nursing callback.
What holds in OvaFlow
- Right patientWrong-chart stopIf the open chart isn't the patient the work belongs to, placement stops and the draft is kept.
- Right next stepUnknown is not doneWhen a send may or may not have happened, the task stays open and the EMR is checked before anything is repeated.
- Right next stepOld links open the current instructionA link to an older instruction opens the current signed version instead.
- Right next stepReports kept as saidA patient's report keeps their words and both the reported and received times, and never rewrites the signed instruction.
- Right ownerRead is not acceptSeeing or reading a handoff never transfers responsibility. Only an explicit accept does.
- Right ownerDecline keeps the ownerIf an offer is declined or expires, the original owner stays responsible, so there is never a gap.
Workflows here
Workflows at Trigger
Each row opens the capability. Point at, focus or scroll to a row to see it in a recording from this stage.
- Sources & signed changesEvery instruction traced to its signed source, and every change carried to the work it affects.Seen in: Daily care: a changed trigger, the wrong chart and an unknown outcome
- Checked in the EMRDone means the EMR shows it. Unknown stays unknown until someone checks.Seen in: Artisan: trigger approval, the wrong chart and an interrupted view
- SafeguardsDesigned stops for the moments that go wrong: wrong chart, stale link, duplicate send, mismatched label.Seen in: Elena's iPhone: the current instruction, an old link, an honest report
- Ownership & handoffsOffer is not accept. Work changes hands only when the next person says yes.Seen in: Daily care: the 8:20 PM report and the evening handoff
- Status languageEleven exact statuses, each saying what is known, what isn't, and what happens next.Seen in: On-call nurse iPhone: seeing isn't accepting, declining leaves no gap
Stories
Stories that pass through here
Fictional people, told end to end.
Fictional patient data
- Daily careDr. Mira Lee signs version 3When the late estradiol result arrives, it routes to Dr. Mira Lee, who signs a revised trigger instruction: Ovidrel 250 micrograms, subcutaneous, once at 20:00 PDT on Oct 30 (retrieval Nov 1 at 07:00 PST, 36 hours across the daylight-saving change). OvaFlow shows what changed; the clinical decision is hers.Read the story
- Elena RiveraOne amendment, four commitmentsWhen Dr. Mira Lee signs the revised trigger time on Oct 30, the amendment updates Elena's patient instructions and tracks explicit re-commitment across the operating room, anesthesia and the embryology lab together.Read the story
- Jordan PatelThe chart that was open by mistakeIn the daily-care story, Jordan's chart was the one open on Nora Ruiz's desktop when Elena's revised trigger instruction was ready. Placement stopped immediately, so nothing from Elena's cycle ever touched Jordan's record.Read the story
Step-by-step timing & questions
How Trigger unfolds day by day
The trigger injection restarts meiosis for final oocyte maturation; its clock time locks in the operating room, anesthesia and embryology schedule 35 to 36 hours later—including across daylight-saving transitions.
Exact evening minute · 35–36h before retrieval
Elena Rivera's Oct 30 trigger evening across the 36-hour DST clock
Dr. Lee signs v3 (20:00 PDT)
Patient & familyYour clinic finalizes your trigger time: 8:00 PM on Oct 30, timed for retrieval at 7:00 AM on Nov 1 (36 hours across the clock change).
What holdsSigned order reaches all 4 teamsClinic, EMR & labDr. Mira Lee signs version 3 (20:00 PDT Oct 30 → 07:00 PST Nov 1 = 36h 00m); OR, anesthesia and lab commitments update together.
Right chart & portal check
Patient & familyOn your phone, version 3 appears first; tapping an older text link for 8:30 PM is blocked and redirected to 8:00 PM.
What holdsRight chart + verified portal sendClinic, EMR & labWrong-chart stop blocks placement into Jordan Patel's open chart; after a network drop on Elena's chart, Nora checks the portal log before resending.
Question vs. 8:20 PM report
Patient & familyAt 5:24 PM you ask a syringe question (kept as a question, not a dose); at 8:22 PM you honestly report injecting at 8:20 PM on Oct 30.
What holdsReported time kept alongside orderClinic, EMR & labPatient-reported time (20:20 PDT, 35h 40m interval) is kept alongside the signed 20:00 PDT order without overwriting it.
Evening on-call handoff
Patient & familyYou know who is calling you back tonight while your physician reviews the 20-minute timing difference.
What holdsViewing is not acceptingClinic, EMR & labNora offers the callback at 20:26; on-call nurse Alex Kim, RN accepts at 20:28 while Dr. Mira Lee retains the clinical interval review.
Worked example: Oct 30, 16:45 → 20:28 PDT: Elena Rivera, Nora Ruiz, RN, Dr. Mira Lee & Alex Kim, RN
Worked example · Flagship daily-care sequenceFictional patient data
Oct 30, 16:45 → 20:28 PDT: Elena Rivera, Nora Ruiz, RN, Dr. Mira Lee & Alex Kim, RN
What the patient sees
Elena sees '8:00 PM, Oct 30' on her companion screen, asks a pre-dose syringe question at 5:24 PM without marking the shot taken, and reports '8:20 tonight' at 8:22 PM.
What the clinic team sees
Clinician surfaces show 24-hour times: signed 20:00 PDT vs. reported 20:20 PDT (received 20:22 PDT), a 35h 40m interval to the 07:00 PST Nov 1 retrieval across the 02:00 fallback hour. Alex Kim accepts the nursing callback at 20:28 PDT.
Why it holds: Six safeguards work in sequence: wrong-chart stop, unknown-outcome hold, superseded-link block, report-kept-as-said, read-is-not-accept, and decline-keeps-owner.
Where OvaFlow fits
How OvaFlow works beside the clinic's own EMR and lab
Coordination companion
What OvaFlow coordinates
- Versioned trigger amendments, elapsed-hour calculation across daylight-saving changes, and 4-team schedule awareness
- Wrong-chart stop, portal publication reconciliation, and superseded patient link blocking
- Side-by-side display of signed trigger time (20:00 PDT) and patient-reported time (20:20 PDT) with explicit on-call callback handoff
System of record
What stays with clinicians & the EMR
- Choosing the trigger medication (hCG, GnRH agonist or dual trigger), dose and target interval
- Deciding whether a 20-minute patient-reported discrepancy requires adjusting the operating room retrieval time
- Authoritative order entry and medication history inside the clinic's own EMR
Common questions at this stage
Questions from patients, families and clinic teams
View all 4 stage questions & answers
Why is the trigger-to-retrieval interval set at roughly 35 to 36 hours?
As SART and ESHRE guidelines explain, the trigger injection mimics or induces the luteinizing hormone surge that resumes oocyte meiosis and loosens the egg-cumulus complex from the follicle wall. Retrieving too early risks finding immature eggs that do not release from the follicle; waiting too long past 36–37 hours risks spontaneous ovulation before the procedure begins.
Sources: [5] ESHRE Guideline Group (2026) · [6] SART Patient Guide (2026)
How can a daylight-saving clock change cause a 1-hour error in retrieval timing?
When clocks fall back from Daylight Time (PDT) to Standard Time (PST) at 02:00 on Sunday morning, an extra elapsed hour occurs between Saturday evening and Sunday morning. If a schedule calculates '36 hours' by wall-clock arithmetic without timezone-offset awareness, retrieval can be booked at 37 elapsed hours. OvaFlow displays both wall-clock times with timezone labels and the true elapsed duration (36h 00m).
Sources: [6] SART Patient Guide (2026) · [18] ONC SAFER Guides (2025)
Why shouldn't a patient's late injection report overwrite the prescribed trigger time in the chart?
Clinicians need both facts: what was prescribed and signed by the physician (20:00 PDT) and what the patient actually experienced and reported (20:20 PDT, received 20:22 PDT). Keeping both timestamps side by side lets the physician see the exact 35h 40m interval and decide whether the 07:00 PST retrieval slot still holds.
Sources: [6] SART Patient Guide (2026) · [18] ONC SAFER Guides (2025)
What happens if an on-call nurse views a callback request on their phone but is in the middle of another urgent call?
Reading a notification never transfers ownership. Until the receiving on-call nurse taps Accept—or if they tap Decline—responsibility remains visibly with the sending nurse so the patient's evening callback never falls between shifts.
Sources: [18] ONC SAFER Guides (2025)
Clinical & operational sources for Trigger (4 primary guidelines)
- [5]ESHRE Guideline Group (2026) — Guideline on Ovarian Stimulation for IVF/ICSI (v2.3 update)Individualized gonadotropin stimulation, ultrasound and estradiol monitoring cadence, trigger criteria and luteal phase support.
- [6]SART Patient Guide (2026) — ART Step-by-Step Guide: Oocyte Retrieval and Embryo Transfer8–12 day stimulation window, 35–36 hour trigger-to-retrieval interval, 15–30 minute sedated retrieval, Day 5–6 blastocyst culture and progesterone support.
- [8]ASRM Practice Committee (2024) — Prevention of moderate and severe ovarian hyperstimulation syndrome (OHSS): a guidelineRisk factors, alternative trigger strategies, post-retrieval symptom surveillance and elective freeze-all conversion.
- [18]ONC SAFER Guides (2025) — Test Results Reporting and Follow-Up & Contingency PlanningClosed-loop tracking of expected diagnostic results from order to clinician review and downtime reconciliation.
Along the spine
Keep walking the journey
Plans can change at almost any point. See how a change of plan is handled.
See it with your team
Walk the trigger evening through with us.
We'll go through the prototype walkthroughs for this stage and the questions your team would ask first.