I’m going to try and be as generic as possible so that hopefully these tips work across different specialities and settings for both in & out of hours. Over time you will find what works best for you and the team you are working in
Whenever and wherever you are working, the most important tip is teamwork. Make sure you communicate with your team regularly & have a single job list. It avoids two of you doing the same job & things getting missed. You can always ask for advice with a particular task and can reallocate tasks if one of you has more left to do than others
On the ward
Most wards have a daily ward round whether this is led by the consultant or just you reviewing patients by yourself. This is where most jobs are generated, as the ward round progresses keep a list of all the jobs so you avoid having to go back through all the notes later on. It may be possible to do some quick jobs during the ward round.
Splitting the ward
If there are lots of you it may be possible to divide the patients between you. So that each of you are only looking after a bay for example. This allows you to focus on these patients. You can join the ward round when it is in your bay and then peel off to start doing jobs.
Even if there are only a couple of you can see alternating patients or bays, preparing the notes or doing quick jobs whilst the ward round is seeing another patient.
Another way of dividing the workload during the ward round is to have somebody that doesn’t follow the ward round, but instead concentrates on doing jobs. These may involve referring patients to other specialities or writing discharge letters. A disadvantage of this strategy is the ward round is a good learning environment.
It can be really difficult to work out which are the most important jobs
- Unwell patients – I would always try and see and sort these patients first.
- Investigations – if a patient requires an investigation such as an x-ray, CT scan or blood test. The earlier in the day you request it the more likely it is to get done the same day.
- Referrals – Similar to investigations, if you want a patient seen today, better to ring earlier. People on the other end of the phone have to try and prioritise their workload as well so the soon they know about a patient the better. They are less likely to be grumpy if you ring then a 10am rather than 10 to 5.
- Discharge letters- probably the one nursing staff will harass you most about. Most hospitals have a cut off time for when discharge letters have to be submitted (to request the medications to take home). Discuss with nursing staff which patients are the priority (e.g. going home first, lots of changes, blister pack which takes some time to prepare) and try to do these ones first. Aim to at least prepare the discharge medication early (ideally the previous day). Although you might be busy take your time as it’s much easier and ultimately faster to get it right the first time round.
- Preparing Discharge Letters –Often will get asked to start preparing discharge letters for patients who are going home in a few days. On the whole, I would generally leave these until all other jobs have been completed. Be selective about the discharge letters you are preparing. Personally, I would only prepare discharge letters for a patient who is going home the following day or the day after. Any more than that I feel you run the risk that if anything happens in the meantime it might be missed in the discharge letter. Equally, if you are discharging a patient who has a discharge letter prepare a few days beforehand make sure it is checked and is up to date.
Out of hours
Again, I would always try and prioritise seeing unwell patients ahead of everything these. It may be that you have multiple unwell patients at the same time which can be difficult. If you find that you have lots of unwell patients communicate it with the rest of the on-call team as it may be that jobs can be reallocated to help you.
Other tips to help you out of hours.
- Ask the nursing staff to start doing investigations before you come to see the patient, eg Bloods, ECGs, Peak flow, get trays for cannulas etc.
- Try and do all the jobs in one area or ward before moving to the next. Saves you walking backwards and forwards.
- Try and do similar jobs at the same time. For example, chasing bloods.
- Always think whether a job can be done by their usual team. A useful question is “will doing this job out of hours, change the management of this patient?” For example, updating families is often done best by the team that knows the patient best & different people having different conversations can make things quite muddy. Similarly confirming an NG tube x-ray for feeding overnight might be more dangerous than necessary
- Always think whether a job can be done by someone else (who will frequently be faster!). Nurses & other healthcare professionals have spent many more years in a hospital than you have. Acknowledge their skills and request their help. Nursing staff escalating to the nurse in charge can be incredibly helpful
- If a patient is in pain (or nauseated, constipated etc.) give some pain relief or other treatments first. It is better for your assessment & them that the patient’s symptoms are better when you get there
By Dr Edward Alcorn FY3 (Junior Clinical Fellow)
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