WEEKDAY on-call (off-site) commences 0600 until 0730.
This allows night cons to prepare for and travel to their daytime commitments in a timely manner.
Contact 9121 (DA Phone held by SR overnight) on arrival. If 9121 in theatre attend OT to facilitate the night reg leaving (this will usually run into the ECT gen emerg list if on M,W,F).
Otherwise handover at theatre reception desk. Ideally night reg should know/have seen the first patient for the general emerg list.
Identify any sick calls/unexpected absences/unexpected private patients on reg only lists. It is rare to have reg only lists in the morning.
Available consultant should be present from 0730 to be allocated. If no available consultant send SR (or mid-range) to clinic and use SMAC consultant. If two lists have sick consultants ask someone to give up office session.
Collect theatre allocation sheet (Helen often prints and leaves on desk). Compare with board as theatre coordinator may shift theatre allocations on day.
Collect overnight sats monitoring forms to review patients.
0800 Theatre start time
Identify any patients remaining to be seen for:
- General emergency list (after ECT M,W,F).
- Ortho emergency list (PM list everyday).
Check bookings file next 3 days (picks up plastics, scopes, gynae, urology etc and patients with planned delay as unstable, coagulopathy etc.
Check handover station (in theatre office corridor) for patients who have been seen and need further Ix/follow up.
As a priority see most urgent, sicker and older patients first. Check who is doing emergency lists. If they are doubled up, can potentially get registrar to see patient.
Other possible delegations: available consultant, obstetric reg, pain reg, obstetric consultant (in that order). Avoid pain reg in morning before 11am (on pain round).
- Get assessors to photocopy anaesthetic forms and staple to booking form for slots.
- Give photocopied assessments to anaesthetist on the day.
- If patient not to be done today place in the ready section of handover station.
- If patient not ready place in assessing section.
- Review overnight sats patients (? Diagnosing OSA needing followup, ? safe for discharge? Safe for cessation of monitoring).
- If all older and sicker patients are seen and have time, see all other patients.
- Phone calls – give advice to referee regarding investigations/management/ referrals.
- If patient complicated or unbooked get them to fax a referral through.
Sats monitoring review
Sats monitoring review It is best to endeavour to see these pts early before they may be discharged and you may be busy elsewhere. The purple (pain) forms are on Helen’s desk for those requiring review. These patients may have undiagnosed OSA or diagnosed OSA without CPAP. Review the notes, obs chart and speak to patient. If desaturation has occurred and you think this is due to new analgesia consider continuing continuous sats monitoring at least overnight. If continued new opiate analgesia on planned discharge consider the safety of this. Try to avoid strong opiates and advise abstinence from alcohol/drugs/sleeping tablets. If desat/reports of apnoeas in undiagnosed patients have team refer for sleep study or GP follow up.
0945-1100 morning tea breaks Anyone who is alone or with an inexperienced junior. Generally juniors should not be left alone for extended periods until they have passed their 3 month assessment. It is a good idea to visit each theatre at least once to make sure consultants and registrars are happy and there are no unexpected absences. Endoscopy and eyes usually stop for a break.
1230 Consultants with difficulty getting lunch/ late finishing before PM list should contact you to organise breaks or cover. The onus here is on the consultant in the list to let you know but try to anticipate problems.