General Expectations on call 

General expectations will vary between hospitals, rotations and your grade. However there are somethings that will almost certainly be expected to come up on the standard on call. 

This includes;

• Post take ward rounds and completing the jobs generated 

• Clerking new admissions 

• Assessing and managing the deteriorating ward patient 

• Requesting and reviewing investigations 

• Prescribing 

• Responding to emergency calls or completing post op reviews 

• Working with the on call team and the MDT 

• Making referrals to other specialities 

• Assissting in theatre if surgical rotations 

This list looks like a lot but don't forget there is an on call team and not every job will fall to you. The important thing is to keep an up to date jobs list so you know what jobs are pending and can start to prioritise them.

Managing the bleep 

The bleep system varies from hospital to hospital and may even be a phone based system in some places. Regardless the principles of managing the never ending bleeps remains the same. 

Answer as soon as practically possible. It's not always possible to answer a bleep immediately, but do answer when you can otherwise jobs pile up and it's easy to feel overwhelmed. 

When you do answer make sure to information gather as much as possible 

• Who is the patient?

• What’s the problem? 

• NEWS? 

• Patients current state – unwell, drowsy, confused? 

• What does the person calling want – advice, review? 

In these situations the more information the better. There are few things worse than knowing you have a job but not knowing where it is or who the patient is. Information gathering is also really useful when it comes to prioritsing jobs, because knowing that you have a stable patient who needs review of their blood pressure medications vs a patient with new onset hypotension makes it a lot simpler to decide what comes first. 

The powerpoint attached has some examples of how to efficiently prioritise jobs. I will preface this by saying 10 doctors might all have different opinions when it comes to the order of the less urgent tasks but would all agree on those urgent and immediate jobs. 

Prioritising jobs 

Priorisiting jobs can feel like an incredibly difficult task at times. A way I've found particulary useful is to split it into 

• Important and urgent - these jobs come first eg NEWS 7 

• Important but not urgent - Regularly work on but can be left for a period of time if necessary 

• Not important but urgent - Deal with efficiently or delegate eg cannula resite for antibiotics in 2 hours, perhaps a member of the MDT is available 

• Not important and not urgent - The hardest to group things into but think non urgent paper work like fit to fly letters. 

The above is just one such structure and I know others who will grade it into a traffic light system of red, amber and green jobs where red signifies a need for urgent management, amber is soon and green tends to cover more routine jobs that can wait if necessary.

• RED - NEWS 7, Critical bloods results - K+ 7mmol/L, Periarrest calls 

• AMBER - review fluid balance, pain reviews 

• GREEN - Routine TTOs or discharge summaries  

When to call for help 

This is not an exhaustive list but as a guide with some examples 

• Patient not responding to treatment

  • Ongoing hypoxia despite oxygen 

  • Rising lactate 

  • worsening pain 

• You are unsure of diagnosis

  • or concern despite normal observations

• Patient looks critically unwell

  • signs of shock 

• Escalation decisions needed

• You feel out of your depth

Stay calm, call your senior and use tools like SBAR to give a clear patient review. 

Assess, action, reassess

Whenever you make an intervention eg fluid bolus, you should aim to reassess in an appropraite time scale. Using fluids as an example, after a 500ml bolus you should repeat blood pressure monitoring to see if it has any impact. 

If your intervtion isn't changing things or the patient is getting worse, its a sure fire sign you need to escalate to your seniors for support. 

Remember you are just one person so take it one job at a time. You will get interrupted and find you constantly have a newer and more urgent job to get done .  We've all been there. Speak to the seniors around you and they might also have some good advice on how to prioritise or may be free to help. 

Disclaimer:

This is a not for profit education resource designed for new resident doctors. All information serves as a guide to help doctors approach day to day life as an F1. It is not intended as a guide to patient care and should never be used as such or in place of advice of treating clinicians or published clinical guidelines. All cases are fictional and any resemblance is purely coincidental. Additionally all images are AI generated unless otherwise stated.