The daily schedule of an Emergency FY1 is highly variable. Below serves as a rough idea
0800 - 0830: Morning Handover at Osterley Office. Night Reg and SHO will handover any new admissions and run through the list with the day team. Hence, have a Computer ready to put out bloods/order scans/prep ward round notes.
0830 - 1200: Ward Rounds
1200 - 1500: Completing Ward Round Jobs + Answering Bleeps
1500 - 1600: Reviewing Bloods
1600 - 1700: PM Handover outside Theatre 5 with Consultant/Registrar + Handover to Twilight FY1
• The op-notes: found under structured notes on Cerner
• CWH:EDM: for endoscopy reports, clinic letters
• Scorpio: endoscopy reports/images
• Somerset: MDT notes
• ECGs: EDCASCARD (for A&E ECG) or bedside notes
• If they are a referral patient from another hospital, referral letter can be forum on the
structured notes or on evolve
• If a patient has come through ED, a very helpful clerking can often be found on the patient’s
structured notes.
If you arrive before 0800, put out bloods for any new overnight admissions on the phlebotomist list.
In the morning, discuss with the Night SHO/Reg if any patients have been added to the list and print out the list
Most communication within the team is done via WhatsApp so take down numbers of SHO/Registrars/Consultants in your team.
To print to Osterley 2 printers -> Print list to "OSTERNBA01" (Counterintuitively)
During the ward round, important information to present to team include
a) Presenting Complaint/Operation (under "op note" in the structured notes - really important to also look at the post op plan)
b) Obs (If scoring in the NEWS chart, why? - Hypotensive? Desaturating? Temperature Spikes? etc
c) Blood Results - Note any abnornmal results e.g. Raised inflammatory markers, Electrolyte Derangements etc.
d) Intake/Output Charts - NG Tube Output, Urinary Catheter Output, Stoma Input, Fluid Intake etc.
e) Useful to have PACS running in the background for the team to review any scans
During the ward round, use the box method to jot down a list of tasks on your printed sheets. This method provides a clear overview of tasks, facilitating eazy prioritization after the ward round.
Main jobs generated include: Requesting and Chasing Bloods, requesting scans, referrals, and completing Discharge Summaries and TTOs
Ward Round with Mr Hartmann (Consultant), SpR Alvarado, SHO Murphy
Issues:
1) POD 2 Lap Cholecystectomy
- Pain on postoperative Site Improving
2) Electrolyte Derangement
- Currently correcting Magnesium Orally
R/V Today
- Patient appears comfortable on bed and breathing room air
- Mentioned that pain on postoperative site continues to improve
- Has passed wind but some difficulty with bowel motion
O/E
- Abdominal Exam: SNT
- Surgical wound healing well
Obs (Use shortcuts - I made my own)
- NEWS 0: No recent temperature spikes
Intake_Output
- (If relevent - document NG Tube Output, stoma output etc.)
Bloods (Use shortcuts - I made my own)
- WCC: .....
- etc
Impresssion
Clinically improving POD2 Lap Chole
Plan
- Laxatives
- Continue analgesia regime
- Laxatives: Senna
- Prep Discharge Summary/TTAs
Sharma Ganes
Emergency Surgery FY1
Bleep: 032
At the end of the day, remember to put out bloods for any inpatients for the next day on the Phlebotomist list. On Fridays, remember to put out bloods for the weekend and Monday morning. This will make your life and the lives of your peers covering weekends a lot easier!
Also, keep the comments sections of the Online Handover list up to date. This ensures a smooth transition of care and improved communication within the team