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NATIONAL SURGICAL TEACHING SOCIETY FY Survival Guide HOW TO GET THE HELP THAT YOU NEED 14 September 2023Dr Molly Nichols Education Officer Core Surgical Training (CT1) – Urology Theme, London University of Oxford FiY1 Oxford University Hospitals FY1 Guy’s and St Thomas’ Hospitals FY2 Maidstone and Tunbridge Wells Hospitals FY3 Clinical Education Fellow, Imperial College London Career goals: Urology with an educational roleKEY LEARNING OBJECTIVES By the end of today’s session you should be able to: • 1. Appropriately prepare to make a referral and use the SBAR tool to deliver an effective handover • 2. Collect sufficient information when receiving a handover/bleep • 3. Effectively use the CUSS model to raise concerns to colleaguesWhy is this important? • Get the help you need when you need it - reduce number of calls/discussions • Appropriately prioritise your workloadMaking referralsBefore making a referral…Before making a referral… Specialty?Before making a referral… Grade? Specialty?Before making a referral… When? Grade? Specialty?Before making a referral… When? How? Grade? Specialty?Before making a referral… When? Grade? How? Where? Specialty?Before making a referral… • Know the reason for the referral – Don’t be afraid to ask (CLARIFY DETAILS – timeframe) • Plan what you will say • Pre-empt questions you will be asked • Up to date examination findings • Notes: ECG, drug chart, op note, open up computer notes (WR, clerking, Ix, obs – NEWS breakdown) – • Do not lie/guessSBARSBAR • S ituation • B ackground • A ssessment • R ecommendationSBAR • S Introduction, Question/request (advice/review/referral), urgency, WHY YOU ARE CONCERNED, brief PC/HPC, Pt name and MRN, whereSBAR • S Introduction, Question/request (advice/review/referral), urgency, WHY YOU ARE CONCERNED, brief PC/HPC, Pt name and MRN, where • B Reason for admission, Relevant PMHx (procedures), Ix, Mx so far/current planSBAR • S Introduction, Question/request (advice/review/referral), urgency, WHY YOU ARE CONCERNED, brief PC/HPC, Pt name and MRN, where • B Reason for admission, Relevant PMHx (procedures), Ix, Mx so far/current plan • A Outcome of your review (A>E), Obs, your impression, actions takenSBAR • S Introduction, Question/request (advice/review/referral), urgency, WHY YOU ARE CONCERNED, brief PC/HPC, Pt name and MRN, where • B Reason for admission, Relevant PMHx (procedures), Ix, Mx so far/current plan • A Outcome of your review (A>E), Obs, your impression, actions taken • R Explain what you need and ask their recommendations, clarify expectations – action listRejections... (1) Order: Erect CXR Additional Information: 89 female admitted with R neck of femur fracture. Chest clear, no cough, afebrile. ?chest pathologyRejections... (1) Order: Erect CXR Additional Information: 89 female admitted with R neck of femur fracture. Chest clear, no cough, afebrile. ?chest pathologyRejections... (1) Order: Erect CXR Additional Information: 89 female admitted with R neck of femur fracture. Chest clear, no cough, afebrile. ?chest pathologyRejections... (2) Order: Erect CXR Additional Information: 89 female admitted with R neck of femur fracture. Routine admission CXRRejections... (2) Order: Erect CXR Additional Information: 89 female admitted with R neck of femur fracture. Routine admission CXRRejections... (2) Order: Erect CXR Additional Information: 89 female admitted with R neck of femur fracture. Routine admission CXRRejections... Why are orders rejected?Rejections... Why are orders rejected? o Inappropriate Ix (overlap) o Patient refusal – not informed? o Inappropriate transport o Not vetted o Inappropriate information/unconvincing request o Pt inappropriately prepped (NBM, oral contrast)Rejections... Why are referrals rejected?Rejections... Why are referrals rejected? o Incorrect person/escalation/timing o Inappropriate referral o Disorganised/lacking information o Unclear requestHow to handle rejections... o Clarify whyime o Ask what they suggest you should do o Which change in conditions would warrant re-referral o Document all discussions o Ask for feedback!Taking referralsQuestions to ask… (1) “Hello Doctor, my patient in bed 8 has a NEWS score of 6. Please could you review them?” What other information would you request?Questions to ask… (1) • Who is calling? • Where is the patient?/ pt details • Recent obs – any change?C • What is their impression/concern • Clarify their expectations and explain your intended planQuestions to ask… (2) “Hi, I have one small job to handover. Please could you chase bloods for bed 10, AB on Nightingale Ward?” What other information would you request?Questions to ask… (2) • Background of the patient, reason for admission • Have the bloods been taken/sent – when? • Why are the bloods being taken - what are they concerned about? What should you action and when – anyone to inform? • With imaging… does it need to happen overnight? Has it been vetted, does it need vetting?Questions to ask… • Essentially…. SBAR information! • Caller and pt details • Trend in obsdmission/procedures • Day team plan • If there is a mismatch – what are YOU worried about?Escalation Raising concernsHow to escalate concerns Which approach is most likely to get the registrar’s attention for review? A) My consultant would like the patient to be reviewed today B) I am concerned about this patient’s safety C) This review is discharge dependent D) The patient is NEWS 6 E) I don’t know the plan regarding this patientRaising Concerns: CUSS • Concern • U ncomfortable • un S afe • StopHelpful resources • SBAR tool: https://www.england.nhs.uk/wp-content/uploads/2021/03/qsir-sbar- communication-tool.pdf • Mind the bleep referral cheat sheet: https://mindthebleep.com/wp-content/uploads/2020/10/Referral- Cheat-Sheet-Oct-2021.pdf • CUSS tool: https://www.hse.ie/eng/about/who/qid/leadershipquality/challenging- unsafe-behaviours-presentation.pdfAny Questions? Thank you for listeningFeedback: