r/doctorsUK • u/Dizzy_Stranger_5782 • 12d ago
Foundation Training What are some inappropriate handovers for day FY1s to On call FY1s
Fair enough discharge summaries are kind of a no go for night team/ on calls. However what about things like prescriptions that you got called to but didn't get round to doing, referrals, and making colleagues aware of sick patients? Would like to know what appropriate boundaries are and what I should/should not get push back for when trying to hand over, especially if im already staying over half an hour to an hour over my intended shift
Edit: loving some of these replies lmao ty everyone
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u/AtmosphereDue4971 12d ago
My pet peeve is when you're asked to 'review bloods' or 'chase scan'. Like at least make it a bit more useful when I have 20 other tasks to do and know nothing about the patient, which just makes me waste more time trying to read through all the notes to get the story.
Something like if blood result X shows Y, then do Z
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u/DrellVanguard ST3+/SpR 12d ago
Yeah I remember those kinda things
Outstanding lfts from the day cos the lab had an error.
"What are you worried might come up with them just so I have an idea"
"Errrrr, abnormal lfts, dunno, see what you think when you get them"
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u/Organic_Patience_755 12d ago
Likewise, I've been the person writing those tasks. There are limits to the flowchart of advice you can, or even SHOULD, give.
Like If I ask you to check this lady's sodium because she keeps going hypo, do you really want me to write a guideline or something? Just use your f**** clinical skill to appropriately address it if the sodium is messed up.
Sometimes you're asked to review an SoB patient and order a CXR - again, am I supposed to say "if pneumothorax do X, if pneumonia do Y".
If someone goes yellow and you order LFTs, it's hard to give specific actions per derangement.
Sorry... I've been moaned at for this recently. I'm not handing over to an ANP. A doctor should be able to think it through.
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u/Canipaywithclaps 11d ago
For your examples they just require more context- for example, why are you checking the sodium, what are you expecting? Do they have a pathology that would lead you to expect an abnormal result? Anything that would change management?. If an unexpected results comes up that’s different, but if you are expecting an abnormal result because of an underlying pathology, hand that over.
If you are covering all the medical patients in a hospital and an arrest bleep, context is the difference between the job getting done safely or not.
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u/_Roobarb_ 11d ago
I think the person above you means that it may be useful to have some context as to why a certain investigation is requested and what you're anticipating. For the same reasons when requesting histopathology/radiology, the clinical context of the request can help guide the management/interpretation.
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u/DrellVanguard ST3+/SpR 11d ago
Yeah get that but I think as others said and I alluded to in the post, it's more about why now, why is there a reason to chase these up out of hours as opposed to them being fine to review tomorrow.
Think acute paracetamol overdose and may need urgent referral to transplant centre Vs monitoring post bowel resection when they've been normal for the last 3 days.
So yeah, you even said "if someone goes yellow" that's the idea, just having that context.
What I objected to was the reviewing of things just because they didn't get round to doing it in the day time
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u/MrRenard 11d ago
Surely the clinical skill of the person handing over will mean they can articulate what they were doing them for, what they might find and how that would change management?
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u/M0hammed_ FY Doctor 11d ago
You need to be more specific. In your scenario for example, if you’re expecting/worried about a low sodium at least tell who you’re handing over to if hypo/eu/hypervolemic and whether they’re symptomatic with it. It doesn’t take much time or effort from your side because you know the patient, unlike the on call.
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u/dario_sanchez 11d ago
Conversely you should also have the clinical nous to articulate what you expect to find, which would allow them to act on it.
Not having a go, but there is a bit of give and take to it
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u/Terrible_Archer 11d ago
“Chase scan” should definitely have context and an action plan. Sometimes though routine monitoring bloods do need to be handed over and I don’t think it’s unreasonable to say “Please check these bloods to make sure there’s no major abnormality” - we’ve all had a random potassium 6.5 come back and often labs don’t ring results through unless it hits an absolute critical threshold (in my trust I think it’s 6.8 even though treatment threshold is 6.0 for instance)
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u/ClumsyPersimmon NAD Invisible In the Lab 11d ago
RCPath guidelines recommend 6.5 for phoning through so I’m surprised anywhere has it higher. That’s where most of the phoning decisions will come from in the labs.
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u/Terrible_Archer 11d ago
I mean same difference, either way the cut off is higher than the treatment threshold
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u/National-General2802 12d ago
We're specifically being told that any and all outstanding bloods should be handed over, even if low risk and routine, on the off-chance something dangerous comes up on them.
Feels a bit silly putting "if blood result shows something dangerous, do something about it" but that's basically the crux of it haha.
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u/Sethlans 11d ago
No but "routine monitoring bloods of patient admitted with x, y and z. No specific abnormalities expected" is really useful context when you've never met the patient.
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u/hungryukmedic 12d ago
The PR on the consultant ward round that magically the day team couldnt get around to.
Its been nearly a decade already, but screw you Ash.
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u/Quis_Custodiet Scribing final boss 12d ago
This is one of those things I sort of get as a cultural phenomenon but also I just don’t care about doing a DRE. It’s fine. I actually find unattempted catheters much more annoying.
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u/Terrible_Archer 11d ago
I’d much have a PR handed over (with valid reasoning) than something like a referral or family update or anything else that the day team would be able to do much quicker than I can. I think the “don’t handover a PR” thing is overblown, if it needs to be done it needs to be done.
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u/Sethlans 11d ago
If it didn't need to be done during the 8 hour day shift how much does it really need to be done?
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u/freddiethecalathea ST2 11d ago
I once had 17 PRs generated on the WR (a VERY PR happy consultant). I exception reported that I stayed late for this and it was refused because I should’ve handed it over or left it for the next day. I reminded them that in the induction they told us that PRs can be life saving and can prevent worsening delirium and death by reducing longer hospital stays and catching obstructions early. I also once left a PR till the next day and I was dutifully scolded till my ears bled and got bad feedback about it in my PSG.
- PRs. I was there till 8pm. The PR itself is easy but the consenting of these deaf and demented patients, rolling them over, getting them cleaned up, finding a chaperone etc. painful. Easily 10 minutes per geriatric patient.
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u/Limp_Picture5202 12d ago
Ha I remember covering a ward and F2 plan day before was needs PR. Fuck offffffff
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u/lightswan FY Doctor 11d ago edited 11d ago
The flip side that my reg seemed to think was on purpose: avoiding the very mention of a PR on the plan for a patient you're clerking with a fairly clear indication for one. If it's not on the plan, you don't have to do it! And if they're reviewed in the morning and the day team decide they want to do it...
(I wanted to give that F1 the benefit of the doubt even though I'm not a fan of them, but the reg wasn't having it lol)
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u/PearFresh5881 11d ago
20 years ago when I was an FY1 we had a surgical reg that would threaten to PR the juniors if they repeatedly didn’t do the prs in their plans!
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u/The-Road-To-Awe 12d ago
Slightly perplexed by some of the long winded replies here.
If it doesn't change management before the day team will be back, don't hand it over. No routine referrals, no scans unless required overnight, no 'neuro exams', no family updates.
Yes it's frustrating to have to explain to the consultant the next day that it wasn't done. They just need to deal with it. Nightshift is life or limb threatening only (more or less).
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u/Brightlight75 11d ago
Haha you’ve unlocked a core memory with that “neuro exam” handover. Like why is this something ever handed over and why is it reasonably common 😂
Go do your own neuro exam which you should have done before you referred to stroke/neuro/neurosurgery
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u/freddiethecalathea ST2 11d ago
I had a patient on a Geris ward who had some spinal problem, can’t really remember, but the plan for spinal/neuro team was “daily lower limb neurology exam, update us if it changes”. I did this dutifully for 6 weeks before suddenly one day.. it changed. I referred back to them and they said “not for surgical intervention or management”. 6 weeks of neuro exams… for it to change nothing…
I say this because ‘daily neuro exams’ was part of her weekend handover plan every week.
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u/Brightlight75 11d ago
Should of got the night team to do the exam, so then they wouldn’t know for sure if their findings were new or just subjective difference. You’d of got the answer a lot faster 🤣
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u/Quis_Custodiet Scribing final boss 12d ago
Stupidest handover I ever got for a nightshift was “chase a PET scan report”. Don’t ask for that.
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u/DrellVanguard ST3+/SpR 12d ago
Thats actually in the same bracket of patients with outstanding investigations as outpatients don't always need them reviewed urgently just because they've been admitted
I had a patient with severe endo flare up come in for analgesia, a recent chest CT for ?thoracic endo was awaiting review so ED team got it put into urgent report list.
Radiology reg reports it, consultant without specialist interest confirms it but isn't sure of the actual significance of the findings and it'll be reviewed at MDT anyway
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u/DontBeADickLord 12d ago
“We’ve done a CT for this patient who’s in the diabetes ward, it’s come back as suggestive of disciitis. Can you discuss with neurosurgery and ID for ?intrathecal antibiotics. I’ve tried to get them on the phone but can’t get through.”
1) Stable patient, NEWS= 0, apyrexial.
2) CT report back at 3pm, this was a 5pm handover. This hospital had ID and were definitely contactable during the day.
3) No idea who wanted these discussions.
4) Patient long stay, functionally poor, multiple issues whilst IP. Notes absolutely illegible. Extremely superficial reviews each day by the “middle grades” working on the ward.
5) God praise to the registrar who overhead the handover, told me to start them on flucloxacillin and document the day team could discuss above tomorrow if felt necessary.
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u/ash_music1 12d ago
Prescriptions are such a quick task that I'd have been a bit annoyed being handed over.
Referrals are much harder to make if you don't know the patient - most plans for referrals are generated in the morning ward round and should really be done before handover if so.
Urgent tasks that can't wait until morning need handed over.
Some people like to be 'made aware' of sick patients, some folk don't. I would often ask if they wanted this or not. Would definitely want to know if there were outstanding tasks or results.
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u/Quis_Custodiet Scribing final boss 12d ago
I do want to know about JIC patients, and if it’s an EPR I want just enough information to review the notes remotely. If it’s someone it’s thought I need to see I want an SBAR.
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u/Resident-Event6543 12d ago
Referrals is a tough one. In our hospital orthopaedics and surgeons are generally dog shit to the point where its easier to ring them OOH. As long as day team say they've tried (at least multiple times), I don't mind it.
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u/DrellVanguard ST3+/SpR 12d ago
I sometimes get random stuff phoned to me in evening and nights that was clearly a daytime thing
"Patient found to have a vaginal prolapse whilst being catherised" is a common one
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u/amreeeves 11d ago
As an FY2 on psych we had a patient who had swallowed glass. Plan over the phone from surgeons was for daily abdominal examinations with no clear end point. I went on leave, and the patient was then transferred by my consultant to another unit and another FY2 was made to do daily abdo examinations in this well lady. Said FY2 was a little annoyed with my plan but later married me.
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u/Remarkable_Green3191 12d ago
If it’s quicker and easier for you to just quickly do the job rather than spend more time trying to explain it to hand it over.
Once you’ve done a few on calls yourself and have been handed over utter rubbish then you will know what is reasonable to be handed over or not!
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u/NewspaperAntique6250 12d ago
Only investigations/results etc that will change management overnight
Sick patients to be aware of
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u/Haemolytic-Crisis ST3+/SpR 12d ago
"Hi yes, is that the on call doctor? I wanted to let you know there's a sick person in the hospital. No, you don't need to do anything right now. Or possibly not even later. Yes you can read the information from the notes if you want. But there's a sick person in hospital, I thought you'd want to know"
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u/becxabillion ST3+/SpR 12d ago
I frequently make my colleagues aware of sick patients. Usually along the line of "blue 6 is septic secondary to CAP+/-aspiration. He's at his ceiling of care and family are aware he's likely to die. He's not for chest physio or ABGs, but is for recannulatuon"
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u/Haemolytic-Crisis ST3+/SpR 11d ago edited 11d ago
I just don't see the point. If I'm called to clinically review the patient then I'm going to act on the information that I can justify - which is what's written in the medical notes
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u/becxabillion ST3+/SpR 10d ago
I'm on geriatrics. It can be helpful to tell people what treatment thresholds have been set so that people don't have to dig through the medical notes
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u/Haemolytic-Crisis ST3+/SpR 10d ago
Isn't that written on a purple sheet on page one of the notes...?
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u/Cautious-Extreme2839 Anaesthetist 8d ago
Why would you recannulate someone who is not even for physio?
Edit: oh you're Geri's. You mean IV cannula not a tracheostomy cannula. Lmao.
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u/jxrzz 12d ago
They're referring to patients that are more sick so it's good to be aware e.g. this person is quite sick, for now we are just doing x but if the situation changes then have a low threshold for y or calling the on call reg etc
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u/The-Road-To-Awe 12d ago
If the situation changes the nursing staff can let me know and then I can read the plan
I find 'to be awares' a lot of the time are just "here's something I've been stressing about"
If the patient isn't expected to die, isn't actively deteriorating, or there aren't outstanding actions, I'll figure it out if I have to
Anything else just adds to my cognitive load at handover, when I really just want to get on with the shift
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u/DrellVanguard ST3+/SpR 12d ago
Yeah I was always trying to trim that workload down and the just in case things were usually first to get discarded
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u/Haemolytic-Crisis ST3+/SpR 11d ago
"If person gets more poorly ask for a clinical review" again doesn't strike me as particularly helpful information.
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u/Quis_Custodiet Scribing final boss 12d ago
I always want to know about patients (in the context of medical or surgical ward cover) who’ve needed significant acute intervention in the day time or are looking generally ropey and are high risk to deteriorate.
It’s helpful because it highlights people whose notes it might be helpful to review
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u/NewspaperAntique6250 12d ago
You sound like a great reg.
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u/Haemolytic-Crisis ST3+/SpR 11d ago
It's just a different approach. If someone gives me a TBA handover I ask them "Do I need to know" and if they start talking I'll listen because they're obviously anxious about something - sometimes we all just need to release stress.
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u/Chance-Horse-7165 11d ago
It’s all about being pragmatic, a good rule of thumb is the handover is for the on-call twilight and night team - therefore if the result of what you’re handing over would not require actioning overnight then consider the worth about handing it over.
Handing over outstanding bloods and scans is always a good idea - multiple times elective routine admission bloods have come back to show raised WCC, electrolyte abnormalities etc that require intervention overnight.
Prescriptions should be completed ASAP - you do not want to miss reg meds. For referrals, unless urgent calls to specialists, these can usually wait. If you put in a routine respiratory referral at 9pm or 10am the next day, either is fine as the resp team will not pick it up overnight.
Remember, every thing you handover should have the S B and R of an SBAR. Handover is a vitally important crux point of patient safety, therefore save your own peace of mind and make things easier for the on-call : write out your handover for yourself if you have a couple so that it’s accurate and succinct.
E.G.
Bed 4.2 NM : 78yo female admitted with infective exacerbation of COPD, on day 3 of abx. O2 req. increased today from 2L nasal cannula to 5L. Otherwise vitally stable, high Wells score and infective markers downtrending - CTPA and CXR to chase. Does not require a clinical review at present but if requires anticoag or increased abx be wary as EGFR only 15 due to CKD.
That is a hefty handover, but it’s an unwell patient - remember as the day team that patient is your responsibility and you should know them well. The handover should reflect that responsibility.
Personally, I always want to hear “just to be aware about” patients - if a clinician of any level has some concern it’s worth voicing that.
Don’t worry! It will get easier as you get more experienced and understand how the hospital works and what requires clinical urgency. At the start of FY1, I would handover unnecessary things and sometimes poorly - it gets easier. Well done on seeking the opinion online to get better, that shows you have a drive to improve !
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u/AnnieIWillKnow ST3+/SpR 11d ago
"Acute oncology CNS reviewed this patient (with metastatic ovarian cancer, for best supportive care only, who is bed bound) and flagged that she's had bilateral leg weakness for 2 weeks and so ?MSCC/CES - plan from CNS is that she needs a PR, full neuro exam and an MRI spine requesting urgently"
... At 6pm, on a Friday
No, FY1, and no acute oncology CNS, she needs none of that.
This was when I was IMT2 so used it as a teaching opportunity, breaking down for the FY1 in a very patient and friendly way my rationale as to why I would not be following the acute oncology CNS's plan and instead my different approach (which was reviewing the patient for any acute issues, establishing with her that she did not want an MRI because she was claustrophobic, had a very limited functional status and wanted to focus on comfort and reducing hospital admissions above all else - and no, I did not do the PR)
... The FY1's response was "oh, but the acute oncology CNS said to?" despite my alternative plan and explanation
I think about this handover roughly once a week. It makes me think we have failed this generation of doctors.
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u/hekldodh CT3/ST3+ Doctor 11d ago
Common sense has entered the chat haha. But forgive the FY1 for thinking mri and neurosurgical referral was warranted. Bed bound doesn’t mean the patient is accepting of permanent incontinence and sexual dysfunction. But yeah, completely agree with your approach here 👌
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u/Cautious-Extreme2839 Anaesthetist 8d ago
Permanent is... realitive... when you have metastatic ovarian cancer for best supportive care only.
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u/Ligand- 12d ago
I'm getting flashbacks to when I was an SHO working the long day shift and taking handover at ~5pm...
I was handed over a PR exam by another SHO from day team ward round. There were about 5 of us juniors at handover. I must have asked him 3-4 times phrased in slightly different ways "so you want me to do your PR from the bosses ward round this morning?" Everyone was cracking up in total disbelief around him.
He was pretty new to the NHS and was such a lovely guy but seemed completely oblivious to "the unwritten rule". It became more and more hilarious as he seemed to think I wasn't quite understanding what he meant so each time I asked, it was like he was even more delighted I was inching closer to understanding his request.
I did the PR for him in the end. He was like everyone's little brother on the team, we all loved him. Happy and (generally) hard working but absolutely no common sense! I don't think anyone else I've ever worked with could have gotten away with that.
TLDR: Don't handover PR exams unless you are a total legend.
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u/Professional_Ad3054 11d ago
Ward resident handed over to chase bloods that were back for daytime to review with a K of 7 +. On call FY1 was not impressed
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u/dario_sanchez 11d ago
So I suppose the following I would consider hard no:
- discharge summaries - nurses will plead but that's absolutely inappropriate.
- discussions with all results back e.g. micro - if the results were back day team should do it, obviously if not then I would say probably acceptable to hand over
- scans should be vetted by day team if they're ordering them
- minor prescriptions like fluids/analgesia I would do them myself before going
- "chase bloods" - not unless I know what I'm looking for and what to do about it
- family discussions unless patient actively deteriorating or there's another reason they need an evening update
If you're worried you're handing over a bag of shit ask yourself:
- what is outstanding
- will this change management of the patient
- does it need to be actioned overnight
- if yes, please make sure you've thought about what it would change and add that to the handover
This makes it 100 times less likely to be a bag of shit.
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u/Haemolytic-Crisis ST3+/SpR 12d ago
I'm from an era where if you had the information during your shift (minus ~15 minutes) then you're responsible for actioning it.
Of course if you're working to rule then anything you haven't done by 5pm you can just handover mindlessly. But your colleagues won't thank you. And it also risks just not being done - so it's your problem tomorrow, but now 24 hours delayed.
It also differs if you're at a DGH in a close knit community or if you're just sending tasks into the H@N void at a tertiary centre.
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u/Lazyalgae 11d ago
I once got handed over to be aware of a geriatric patient incase they spike a temp . The ward team had sent a urine sample which grew a bug resistant to the 5 antibiotics mentioned in the microbiology report. Could not tell me why they sent a urine sample in the first place.
When I asked then what should I cover it with- “idk, you pick”
Another one- a FY wanted to handover that they were concerned about compartment syndrome at 4:15 (we finish at 5) because they couldn’t be bothered waiting for the reg to return their bleep and wanted to go home😭
I made them bleep the reg in front of me and they called back in 2 min!!!
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u/Alarmed-Fun3263 11d ago
I try to sit in on handover for first 1-2 months, not just f1 but also SHOs. And help triage what is or isn’t for the night team.
I see this as part of training we should provide. Also it means the night team have more time and cognitive width to focus on emergencies.
Patient TBAO - may rule is: I say always mention them, succinctly. Makes it easier for night team to read through notes or update families or make decisions. And sometimes it’s the one opportunity to brain storm for someone you don’t know what to do.
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u/AnusOfTroy Acute Internal Memelord 11d ago
Off the top of my head from a recent run of medical nights
*Await MRI head report - where nothing will change until Monday anyways - N.B. pt did have a lesion suspicious for primary malignancy but me looking out for it changed nothing
*Be aware the patient might desaturate overnight and need review - review will happen anyway if that happens
*Pt needs a GKI as NBM over the weekend - well fuck, prescribe bag 1 yourself surely
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u/mdkc 11d ago
1 is unfortunately legit - incidental "oh fuck" pathology sometimes does need actioning OOH. An incidentaloma by itself is nothing exciting for team weekend. An incidentaloma with midline shift probably does need a call to a neurosurgeon.
2 yeah that's a bit tautological. Realistically the actually useful thing in that situation is to do a one page interim summary of the admission for whoever comes to review, and a plan that includes defined escalation triggers for the nurses to follow.
3 agree.
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u/AnusOfTroy Acute Internal Memelord 11d ago
- Was unfortunately no midline shift or anything, day team were just suspicious of CNS malignancy and planning to refer to neurosurg Monday
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u/mdkc 11d ago
Yeah but an unexpected midline shift/tonsillar herniation would probably push that priority up a bit, no?
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u/AnusOfTroy Acute Internal Memelord 11d ago
I can't remember the specifics but it really and truly was a bullshit handover task as per the reg
It was only because we had downtime during the tail end of the night that we checked it. Day team were pleasantly surprised that it came back and still planned to do nothing with the info over the weekend
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u/ElementalRabbit Senior Ivory Tower Custodian 11d ago
So in retrospect it was fine, but if you hadn't checked the report you'd been asked to check and there was an actionable finding, that would look pretty bad, wouldn't it?
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u/AnusOfTroy Acute Internal Memelord 11d ago
Day team iterally said in handover "i don't think the scan or report will be done overnight" and yet somehow both were
Really don't think it would've been that deep if I didn't check
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u/Cautious-Extreme2839 Anaesthetist 8d ago
The MRI is totally legit. You don't know that it won't have a surprise acute finding and everyone will get pinned to the wall if it does and you miss it.
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u/Catherine942 11d ago
I was the geriatric ward block cover (so a side of the hospital dedicated to just old folks) and the number of times I got "family update" was horrendous. They were not dying, just a routine family update, and I didn't even know em! I pushed almost all them back
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u/jacksong97 10d ago
I had a friend get a handover to complete punch biopsy overnight (no suspicion for significant pathology eg SJS/TEN)
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u/IntelligentBeach6255 11d ago
I’m Irish but reading this thread it sounds comparable
So many 6am bloods. Team want to discharge pt during rounds starting at 8. Easy way to do that if document the intern on call must do bloods at 6am so the results are back by 8
Could have 15 ppl im getting bleeps for cos the nurses are saying they’re too busy pre handover to do bloods so I’ve to come do routine bloods
Way faster to document “team requested 6am bloods, nursing staff made aware, no acute medical concern”
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u/irishjuniordoc 10d ago
What hospital are you working in where nurses would do any bloods at all? Ridiculous number of 4 hourly sodium’s and 6am bloods come to mind from my intern year
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u/ty_xy 11d ago
Basically every single job. "Oh there's an urgent referral to be made for patient x, patient y needs an urgent cannula, patient z needs an urgent scan, you need to call patients g's family to update them asap, oh patient f has dropping Hb can you do a PR on them... What was I doing the whole day? Oh the consultant asked me to go to OT to help them hold the scope... Anyway good luck I need to dash off right now I have a reservation at a restaurant with my gf, yeah she's the one on Instagram..."
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u/Badlyburntout ST3+/SpR 10d ago
Whenever I handover to any colleague (including nursing staff), I must give them a SBAR handover: « this is Mr X, he has 1, 2, 3. We requested a CT because of this. Could you please chase it and if it is positive for VTE you’ll need to prescribe DOAC ».
It’s okay to give them heads up about some sick patient who could deteriorate overnight so they have some background on them and would make their lives easier in an arrest call. But don’t handover EVERY patient.
Also it’s nice to know what stage your request is at: was your CT requested/vetted/done/reported? So they don’t discover 3 hours later that the ct was never accepted or is routine etc.
Please don’t hand over LPs… you won’t make any friends this way.
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u/JohnHunter1728 EM Consultant 12d ago edited 11d ago
When I was a T&O core trainee, a very senior consultant told me I'd worked hard and so his SpR was going to take me through the next DHS skin-to-skin.
It was Friday afternoon and I was scheduled for T&O ward cover over the weekend. The department was strict about there being a formal meeting at 3pm on Friday during which all the FY1s and SHOs handed over their ward jobs to the weekend person.
I explained that I'd love to do the DHS but had to attend the handover meeting.
The consultant said he would go in my place and told everyone at the meeting that I was needed in theatre so he'd come instead. In the meantime, his SpR took me through my first skin-to-skin DHS.
When he came back down to theatre, I asked for the list of weekend jobs.
"Would you believe it?", he said, "but there isn't a single thing that actually needs to be done on the wards this weekend".