Rounds

Surgical ward rounds can be extremely fast, and it can be extremely difficult to keep up. By the time you find the notes, the consultant may have moved on to the next patient!

Here are some tricks to keep up:

• Write the important points from the round (CT brain, discussion of results, pt consented etc) on the bottom of your list and come back and write in the notes later. However this is inefficient in terms of time and you may not be able to manage this if you are busy.
• Take pieces of blank clinical notes paper and write the ward round notes on one page per patient. Go back and put them in later, this saves you messing around with folders, but you won’t have access to the notes for the previous day.
• When most of your patients are on one ward, get in early and put each of the notes outside the patients’ rooms. You can also pre-write parts of the notes that you know will be included – like the headings or drain outputs.
• If you have them, use your medical students. They can get the next files or the bedside chart ahead of time.
• If nothing else, on a manic consultant ward round, just write the plan!
• Finding the NUM after the round and discussing the plan with them is also a good idea. Everyone is on the same page, and often they will bring up things that you had forgotten or might not have thought of.

Prioritising Jobs

1. Anything that is time limited. For example, investigations that have to happen that day, things that need to happen before a procedure.
2. Patients to be discharged. Make sure that your discharge is complete and the meds are in. Hopefully, your discharge is almost done and the meds ordered the night before so this shouldn’t take long.
3. Consults. Get your consults in before lunchtime.
4. After this work on any discharges planned for the next day. Try to at least get the discharge medication list to pharmacy.

Discharge Summaries

Autotext. You can save a bit of time by saving the skeleton of a discharge as a piece of autotext in powerchart, meaning that every time you don’t have to write “Dear doctor…”

Issues

If you have time, try to read through the notes page by page and pick up any issues that occurred during the admission.

During the ward round if you have time, try to create an issues list. What the patient came in with, what the complications were and plans for management. It will make coming back to do the discharge much easier.

Escalating

When to escalate

• It can be difficult to balance wanting to prove yourself and knowing when to ask for advice. Your main consideration should always be patient safety.
• The best way to impress your consultants is to try and anticipate problems (like needing rehab, or preop outpatient cardiology).

How to Escalate

When you do ask for help, don’t just state the problem, you’ll look much better if you say “my impression is this” and suggest a possible management plan.

On surgical terms it can be difficult to get input from your registrars if they are all in theatre or not answering. Things to try:

• Speaking to another registrar. Often there will be more than one team in the same specialty and the other team’s registrars may be available.
• Go to theatres and speak to them directly.
• If you are worried, you can call the consultregistrar of that particular specialty.
• Prevail upon your registrar to use his or her powers to get someone to come to see the patient if you are having difficulties.

Consultants care about their patients and are ultimately responsible for them. If you are worried about one of your patients, they would rather be called.

In the end you can always speak to ICU. If you say that you am worried about this patient” they are going to advise you properly or come and see the patient.