BVH on call & AMU Venu Kollipara
Objectives - Explain the on call shifts at BVH - Numbers on call - Registrar, Junior & F1 both day & night - What roles are required at each - Explain how AMU works - Explain the clerking booklet
Numbers on call Week days - Registrar 997 (9.00 22.00) - Ward cover - 2 juniors (F2, CMTs, ACCS, GPSTs) - Home teams 9.00 17.00 (with one junior responding to arrest calls) - Ward cover 17.00 22.00 - Hospital at night team bleep 600-1 advanced nurse practitioner from 4pm bleep 600 - Acute response team hold 600 during the day
Weekend wards - day time - Registrar 997 (9.00 to 22.00) - Junior *2 (9.00 22.00)- see intranet on call rota for division of wards - Wards - Crash - F1 (9.00-17.00) - Hospital @ night team - 2 ANP - Operated via nerve centre on blackberries - Additional juniors on bank holidays
AMU Weekdays - 3-4 AMU consultants on PTWR - AMU team - 2 F1s, 1 F2, 1 ACCS, 2 GPSTs, - 2 registrars - Registrar 997 based on unit - 2 Juniors (Do Monday-Thursday on call) - 731 (9.00 22.00) - call taker & clerking - 732 (10.00 22.00) - clerking - F1 (17.00-22.00)
AMU Weekends - 3-4 consultants post take on AMU & Wards - Registrar 997 Wards & Resus (AMU if busy) - AMU registrar - Covered by 2 shifts - early 9.00-17.00 - Late 16.00 24.00 - Juniors - 731 9.00 22.00-732 10.00 22.00 - F1 present on unit 9.00 22.00
Nights 21.30 9.30 - Registrar 997 - AMU & Wards - (Occasional additional locum registrar on weekends & busy weeks but very intermittent) - 2 juniors - Based on AMU - 731 call taker & clerking - 732 clerking & crash team - F1 & 2 ANP - Wards & crash team
In summary: Week days: Wards: Registrar, 2 Juniors on Wards 17.00 22.00 AMU: AMU team (Registrar, 2 F1s, F2, 2 GPSTs, occasionally ACCS), 2 on call juniors, F1 Amu 17.00 22.00 Weekends: Wards: Registrar, 2 juniors, F1 9.00 17.00, 2 ANPs AMU: Registrar, 2 juniors, F1 Nights Registrar (occasional 2 nd on AMU), 2 juniors, F1, 2 ANPs
Handover - All handover occurs on AMU - Morning handover - 9.00 at AMU electronic board at AMU hub. - Evening handover - AMU relatives room or if in use, AMU staff room - 21.30 - + 12.30 AMU board rounds.
FY1 - Baton bleep 981 Weekdays - Complete 9.00 17.00 on ward with home team - AMU from 17.00 - collect 981 bleep from AMU F1 - On teaching days, on-call F1 is on AMU all day and does not attend teaching - Complete jobs handed over & report to sister in charge for any further jobs - Clerk patients & discuss with senior - Attend handover at 21.30
FY1 weekends - AMU - Attend handover at 9.00 - Accompany consultant on ward - Complete ward round jobs - Complete TTOs - Clerk patients & discuss with senior - Attend handover at 21.30
Weekend wards - 9.00 17.00 - First on call for jobs on: - Stroke - 23 & 24 Respiratory Wards - 18 Endocrine Ward - 19 Short Stay ward - Jobs via nerve center - Bleep Junior at 17.00 with outstanding jobs & to inform about sick patients
Nights - Cover medical wards with 2 nurse practitioners from hospital @ night team - Jobs listed on nerve center via the blackberry - Try to pop into the hospital @ night office prior to nights to ensure you can get on the system and someone can show you how it works - Any concerns or questions, discuss with the registrar - Clerk any patients on Hematology & Stroke who are admitted directly to the ward - Discuss these with the registrar - Attend Crash calls & medical emergencies - Attend handover 21.30 & 9.00
Junior on call Crash - Week days - works with home team 9.00 17.00 - On crash team all day - At 17.00 will cover: - 23 / 24 - Respiratory - 25 / 26 - Care of the Elderly - C General medicine & oncology - Haematology (Ward E) - Weekends entire day on wards (occasionally need to attend WR on AMU) - Clerk direct admissions to Haematology ward - Escalation to Registrar if any concerns - Attends handover at 9.00 am (weekends only) & 21.30
Wards - Week days - works with home team 9.00 17.00 - At 17.00 will cover: - 2 General Medicine/Care of the Elderly - 11 / 18 Endocrine - 12 - Gastro - 19 (SSW) - Stroke (33/34) - 6 & Cardiac Day Case occasionally used as escalation wards - Outlying wards - Weekends entire day on wards (occasionally need to attend WR on AMU) - Clerk direct admissions to Stroke ward - Escalation to Registrar if any concerns - Attends handover at 9.00 am (weekends only) & 21.30
Ward cover - The wards are also covered by the hospital at night team - Usually one ANP on late and 2 on nights but some changes recently in order to cover Clifton rehab hospital out of hours. - This means the evening shift is not always covered - Nights and weekend jobs are completed via nerve centre - These are accessed via a blackberry which you will carry with you - Jobs are then allocated to different doctors/anps - Please call in early on your first shift and ask the hospital @ night team to explain the system & how to use the blackberries
Amu on call 731-9.00-22.00 - Attend handover at 9.00 - Take 731 bleep & 732 until 10.00 - Take all referrals from A&E - Take GP referrals out of hours and when no ANP cover - Add patient to electronic system - Attend handover at 21.30
Referral tips - Medicine accepts: - Chronic pancreatitis but not first presentation - See abdo pain proforma, surgeons generally need to at least see patient unless very clear cut medical problem - Chest pain - For repeat trop s & NSTEMIs - STEMIs go straight to cardiology - Cardiology also take - Chest pain if they are under active cardiology follow up, if the chest pain sounds cardiac & is on going, sometimes! If these are present ask them to discuss with cardiology first, if unsure ask consultant or registrar on call - If GP phones, chest pains need to be reviewed in A&E first! - Stroke goes to A&E (if GP referral) & from there directly to stroke ward don t come to AMU - Try to ask about cultures, abx, fluids, CXR - these should be done in A&E prior to transfer - Give the nurse in charge warning if patient is likely to need a side room- input on tracking system
Utilise PCAU - Primary Care Assessment Unit open mon-fri 9.00 17.00 - Mon Friday 9.00 18.00 NP takes GP calls - If she is off, 731 will take calls - GPs usually able to inform you if they think their patient is appropriate for PCAU - Essentially any patient who could possibly be discharged on the same day - Obs need to be stable - Need to be mobile - Can arrange transfusions on there electively - Acceptance criteria beside electronic board in AMU - If not sure, ring down & ask!
Ambulatory care Combined assessment and treatment unit. Medical and surgical. Same day service. Short stay unit: less than 48 hrs stay.
732-10.00 22.00 - Clerking patients - Holds 731 when they are on break or doing a procedure - On the crash team at night - Responsible for taking the grab bag from AMU to arrests, please see ANP at start of shift for direction regarding this - Attends handover at 21.30 and 9.00 if post nights
Registrar on call - Baton bleep 997 (9.00-22.00) - Lead Crash calls - In charge of take - Awareness of number of patients to be clerked, escalate if necessary - Clerk unwell patients in A&E resus if contacted directly by A&E team - Senior reviews - Unwell patients & patients prior to transfer from AMU to wards - Thrombolysis for Stroke & PE - Review patients referred by other specialities - Helps with clerking, especially at night
AMU - 36 bed ward - Currently 3 consultants - Clinical Lead Dr Kollipara - Take 35 50 patients average
Clerking - Patients to be seen - Identified in order of arrival by time on the AMU tracker system - Patients who are unstable will be triaged as yellow or red, red being more unstable - Patients clerked in the order of red, yellow, green then time - When clerking - Click on the patient, put your name to show that you are going to clerk that patient - When finished, enter your diagnosis & click clerking completed so they can be highlighted for senior review
Admission document Call taker documents name, DoB & hospital number if available C Call taker documents brief history Call taker documents their name, date & time call taken and where call from History Essential that you document NAME, GMC, GRADE, BLEEP (NOT ON CALL NO) DATE & TIME
PMH & Drug History are essential - Notes can take time to come to ward especially at night - Use Vision Portal - Vital information all letters to GPs, discharge summaries & MIG GP record of PMH & Medication list
Patients who are confused: try to always ring nursing homes or relatives to get an idea of their baseline Smoking & alcohol recording is often audited, if you can complete these, please do
Examination findings
Dementia screen monitored daily
Investigation results space for baseline bloods
Diagnosis, plan, and sign date & GMC number again
VTE assessment prophylactic agent in BVH is 5000units dalteparin
Pathways Pathways in place for: - Sepsis - Community acquired pneumonia - COPD - Stroke - Acute Kidney Injury - Abdominal pain - (Neck of femur pathway)
Teaching - Lunchtime - Departmental teaching - Respiratory: Xray meeting Monday, teaching Tuesday, MDT friday - Gastro: Teaching Tues & Wed, Xray thurs, MDT Friday - CoE: Teaching Thursday - Endo: Teaching Tuesday - Most provide lunch!
Trainee representatives August 2015 August 2016 Muna Parajuli CT2 Email: parajuli.muna@gmail.com Currently based on Care of the Elderly Wards 25 & 26 Until Early September 2015 Aoife Lillis ST3 Email: amlillis@gmail.com Based on Respiratory - Any questions please ask!
Questions?