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Hello, everyone. Welcome to our second lecture of the Fy Survival Guide. Um We've got eight sessions in total and we've got some exciting lectures lined up for you. So be sure to sign up for those as well. Today with us, we have Molly who's ac T one in urology and she's currently working in London and today she'll be talking you through things like making referrals, knowing who to call and how to get the help you need. So, over to you, Molly, thank you, Luca. Hi everybody. Welcome to the talk and thank you so much for joining us um this evening. Um So for today's session, there will be a bit of use of the meter uh which you guys can access, using the code or the QR code that will come on the screen. Um But all times there's the messages at the side. So if it's all you have any questions, do feel free to pop them into the chat box and I'll be monitoring that as um no question is too big or too small. So please do ask away. So without further ado we'll get started. So today's session as Luke um introduced is how to get the help that you need. So I think this is a really important topic for when you start work as a foundation doctor because often these skills are things you have to pick up on the job because often it's not taught super well at medical school. So hopefully after today's session, you'll feel a bit better prepared um for these kind of interactions that you have on a daily basis on for um job as a foundation doctor. So just a little bit about me. So I'm one of the education officers um uh at the society and I graduated from the University of Oxford in 2020. Um I did my interim foundation in Oxford, which was the kind of COVID workforce, um did my foundation in Thames and just finished a, a clinical education fellow at Imperial. Um And I'm starting my CT one shortly um in London. So if you have any questions relating to that as well, then feel free to ask away. So today's session, what we're gonna do is we're gonna go through the par to which I'm sure some of you are familiar with and work out how to deliver an effective handover. These are really important communication skills, not only to ensure that you're kind of providing appropriate patient care, but also it makes your life a lot easier. If you're able to make those referrals uh effectively on the first attempt, then you just work work down massively. Um, and you'll find that it's much easier to kind of get on with your job. And we'll also, as well as kind of making the calls. We'll also talk about taking calls or taking handover and the information that you have to ask to really get the most out of that. Uh, and then we'll also go on to a topic which can be quite tricky, which is escalating concerns to a senior and actually making sure that um your voice is hard and people are listening to you when you, when you want to get help. So you're not dismissed because that can be something that can be really quite daunting when you're starting, particularly as a foundation doctor. So we'll use a model to um help provide a structure for that. So, as I've mentioned before, um I think it's really important because it will help you to get the help you need when you need it and it will reduce the number of subsequent kind of calls and discussions that you have because you're getting it right first time. Um It will help you also to be able to appropriately prioritize your workload. Um because you're able to get the information you need from the people who are handing over or bleeping you. So some of the skills that you learned if you attended our first session um will be kind of brought back in today. So hopefully, if you did attend that you'll be able to kind of recall some of the learning points from that first session. So we're gonna start off with making referrals. So you're the one who's asking for help from someone else. So I'm gonna start off with the men meter and so the code is there 79290543 or you can use the QR code and I just want you to have a little think about what kind of stuff you need to bear in mind. Uh Before you make a referral, before you pick up the phone or before you go to see the person, what kind of stuff do you need to establish what you need to bear in mind? I'll just have a look and see which answers we have coming through and you can also pop pop responses in the chat if you'd like to. Excellent, really good. So people are saying kind of having a structure to the referral. So thinking about um SB a structure really, really good. Um excellent. What question you want? Yeah, really, really good. So thinking about also characteristics of the patient, so their social history, their mobility, their past medical history. Um really good responses so far. Thank you so much guys. So um all really key. So as well as thinking about the patients specific things, there's a few logistical things that you want to get right at the start which again will make your life easier. So things like which specialty am I referring to? Sometimes that's really obvious and sometimes it's a bit less. So maybe the patient needs intensive care, maybe they need a particular surgical specialty, maybe they need a particular medical specialty. In some that kind of tertiary centers, there might be multiple different types of respiratory doctor, um different kind of subspecialties and sometimes in Ad GH. So the district general hospital you might have, for example, general surgery might be covering people who have um uh an a a bleed on the brain. So it's worth asking your colleagues, which is the best specialty to help me out here. And it's also important to think about what grade you want to be speaking to. Would you like to be discussing with an F one, maybe registrar, maybe an? So I think often if you want to refer a patient. So if you'd like the care to be taken over by a different team, it's worth asking a registrar. Um But often they can be busy, particularly in surgery, they may well be in theater. So sometimes the sho is a good bet. They might often be together or at least in communication with each other. So sho or registrar, often both of them can be quite helpful. Um Also, so we've got a question. So I might come on to that in just a little bit. Um Once I've covered this so that we can kind of bring it all together So, um, do remind me if I forget. Um, when, so another thing it's important to consider, particularly if you're working at the weekend or working on a night time, is it actually a appropriate to be referring this patient out of hours? Um, maybe it'd be better to do it in, in the week. So this is something that you can ask your, if you're working on the weekend, they're asking you to refer to the medics, you can say, ok, is this something that we need doing this weekend or is this something that can be put in um, over the week and then how to talk to them? So sometimes referrals are via email, they might be via the online kind of computer system, they might even be in person and sometimes you might want to bleak them or um, call the switchboard to get through to them. And this is an app that not affiliated with, with the society and, but it's a helpful app called Induction that has a lot of um, telephone numbers within it, like a directory. And that can be really useful to help you find out the direct numbers at your hospital and also other hospitals. And then finally where so particularly if you're at a District General Hospital. So one of the smaller hospitals you might want to be referring to a specialty that needs quite specialist knowledge that you might not have inhouse in your district General Hospital. So you might even be looking to refer to the hospitals or tertiary centers or maybe your local trauma center, for example. So all of these logistical questions are really important. Um And then also a lot of you mentioned these kind of things. So the the the information about the patient. So providing a structure and preparing to, to use your SB a the patients kind of their past medical history, their social history. It's also really important to know the reason you're referring. So don't be afraid to ask your senior if you read your consultant says, ok, refer to medics. It, it, it's there's no harm in saying and I'd actually encourage you saying, could you just let me know what you want from what, what are you expecting from them? Just so that when I'm on the phone to them, I know exactly what we want. Um And clarify the details like when do we want them to do this review by, do we want to registrar review? Do we want to sho review? Because if you've already asked, seen your those details, you don't need to go and find them later if you get off the telephone. And it's important also to preempt questions you're going to be asked. So if you're ringing cardiology, it's good to kind of get the ECG um in front of you. If you're talking to microbiology, you might want to know what drug, what antibiotics they're on at the moment. So it's worth having the drug chart open on screen or out in front of you if it's paper notes and also a lot of the time you'll be asked questions about the patient. Um, it's important not to be, to kind of lie or guess which sounds quite obvious. But if someone's saying, oh, have they been febrile in the past 48 hours? Uh, you might be tempted to say, uh, no, I don't think so, but you're not actually sure. So make sure that if you actually don't know, you say, ok, let me just check or, or, I don't know, but I'll find out that information so often if you've got up to date, examination, findings or up to date observations, it stops you from being in that tricky situation. Um So I'm just gonna have a look at this question now. So what do you do if you're a de one who's supposed to finish at four or five? But the on call sho who's been asked to hand your patient to arrives but sits in the office and revise. Oh, ok, for the clinical exam. So this is a bit of a kind of situational judgment test. Um Does anybody else want to have an idea of what they might do in the chat? Um And I'm happy to go over it as well. I want to see if anybody wants to kind of check in on what they think. Um If not, I can go through it. I think obviously if you guys have prepped for your, anyone's prepped for that SJT. And this is something that's a bit of an ethical dilemma. I think if somebody that you're handing over to is kind of refusing to hand over or not doing their job role, then I think it might be important um, to, well, firstly discuss it with them and explain that maybe it's not the most appropriate time for them to be revising obviously in quite a um a nonconfrontational way. Um If you find that they're not agreeable to helping you, then it might be worth escalating it to um registrar for example. Um Because yeah, I think, I think if, if somebody is not accepting your handover, then asking somebody else within the team is a good idea. At the end of the day, the most important thing is patient safety. So you need to make sure that your handover is being received and acted upon um appropriately. So hopefully that answers your question. But do let me know if not. So I'm just going to again ask you to have a go pen meter. So some of you have mentioned sar already. So I think you may well be aware of it, but let me know what your understanding is of what S a stands for. Hopefully, for some of you, this will be an easy question and if you're not sure what it stands for, um then don't worry because we'll be going through it together. So the person who was thinking about the, the S A structure for the handover, perhaps you might already know what SB A stands for. Ok. Excellent. So we'll go through it. So it stands for situation background assessment and recommendation. And I think it's definitely something that's being covered a bit more at medical schools now, which is really good because it's an excellent framework to use um when you're making referrals and when you're kind of escalating anything or discussing with another member of the team. So starting off with the situation, um when you ring up somebody or you're asking for advice or referring, it's important to introduce yourself by your name and also which role you are in the department, people get so many calls throughout the day, it's always important to kind of establish that at the start. Um So that they know who they're speaking to and it kind of sets the scene. On the other hand, it's also important that you double check that you've been put through to the right person, particularly if you're going through a switchboard or someone else might be holding the bleep, you might not get the person you're expecting. Sometimes the sho might be holding the reg. So it's worth clarifying, you say hi, my name is so, and so I'm this grade of this department. Could I just double check that I've been put through to the general surgery registrar, for example. Um, I think it's an important to just ask an open question to say what you want. Maybe you want a patient reviewed, maybe you want to refer them to transfer the care or you want to ask for advice so that they know what it is. They know straight away what the headline is. Um, it's important also to establish the urgency so that they know whether this is something that they can come back to or if that's something that you need help with straight away. Um because it might be that they say, oh sorry, I'm really busy at the moment. Ring me back later. But if you said, look, I really need an urgent review of this patient who is um hypertensive saying your headline and the main reason why you're concerned you want to get back in early. So it's very clear um what you're ringing them for so that you can prioritize their workload. Um Sometimes if it's not an urgent thing, you could say, oh, I would like to discuss text with you is now an OK time for you and they might ask you to call back later. Um but it's worth giving a brief presenting complaint. So why the patient was brought into hospital and what their current problem is. Um And if of a history of presenting complaint, um and you can also give them the patient name and the patient number. Um so that they can take a note of it and let them know which ward they're on or where in, in the hospital they are. The next one is background. So that's a bit more detail about their reason for admission. So a lot of the things you guys mentioned before. So the past medical history, social history, their mobility, um it's particularly important to mention any procedures. Um If they've had an operation, talk about what the date of the operation was. Um If you're wanting to be really good, it's worth having look at the operation note as well to see if it was a complicated procedure, what things were like postoperatively because that paints a really nice picture of the kind of postoperative course. You might want to talk about any investigations or management they've had so far and what the current plan is just to really help person who you're referring to understand what the current situation is at the moment. So, assessment, it's good if you're, um as I mentioned earlier, if you're referring or asking for advice that you've done a recent review of the patient, it's really helpful if you've actually seen them yourself as well. Um Because a lot of the questions you'll ask, you might not be able to properly answer unless you have done your own review of the patient. So I would recommend going and seeing the patient reviewing their observations and doing a kind of up to date review and also telling them your impression, it's good to do preliminary actions. If you feel comfortable doing this, when you first start, you might not feel so comfortable. But if they've deat it and you've given them some oxygen via non rebreathe mask, for example, that's something that's worth um letting that person know so they can see that you're taking initiative that you've already put some plan in place. Um and that, you know what you're talking about. And then finally, the recommendation basically just ask why you need the help, what the expectations are, if you're asking them to come and review, maybe let them know ideally when, when you'd like them to review and double check with them, what they've understood almost to create a kind of set of actions. So you can say, OK, brilliant. So I'll do Xy and Z if you're not sure of the plan of the things that you should do in the meantime, when they're way, just ask them, say, is there anything that I can do to prepare the patient? I can get ready for, for your review? And that can help you to kind of get involved in the management of the patient? It stops wasting time. And also if they know that you're helping out, they might be more likely to come and help you sooner if you're getting the, the cannula kit ready, for example, if there's a difficult cannulation or you're starting the IV antibiotics and it just helps you work together as a team, but just really clarifying of the time frames and what you're going to expect, what things you're doing and what things they're doing. Um And I always think it's worth having this two way conversation and don't be afraid to kind of ask them or say, oh, I've not done that before. How do I do that? Or who do I approach to, to do that? Um It's always worth just asking those questions if you're unsure. Um And then here's just a kind of um image from the, the NHS website of the, the SB A um structure and it might be helpful for you to kind of screen or just to be that in mind to use, particularly when you're first starting as your frame work. Um Because with more practice, it hopefully will become a bit more natural, but it's good to have it there in front of you as a bit of a crib sheet for um when you first start. OK. So I'm just gonna talk a little bit about things that you're kind of requesting, being rejected. So we're gonna look at this example, which is uh a chest x-ray order. Um So this is a little bit different to the kind of verbal sar handover. Um So somebody's ordered an uh an re chest x-ray, so a chest x-ray of somebody standing up. Um They've put in the order information that it's an 89 year old female who was admitted with a hip fracture. So a right neck of femur fracture, their chest was clear on examination. They didn't have a cough, they didn't have a fever and they're querying a chest pathology. So this is a rejected order. It is canceled. So I'd like you guys if you can to just scan the QR code or use the Monty code or pop it in the chat. Explain why do you think this has been canceled? So I'll just remove the X so you can have a think why might this have been rejected? What's wrong with that referral? All that request then? Yeah, feel free to pop it in the chat if you feel more comfortable doing that. So I'll just wait a couple of minutes to give you guys some time to think. And if you have any questions as well about any of the terminology and there's a bit of short hand on these sides. So do let me know if there's anything you're not familiar with. So for this one, I guess the issue here is that you're asking for chest pathology. So you're querying that there's something wrong with the chest, but from everything else that you've written in the information, um it doesn't really, it doesn't really suggest that there's any reason for you to worry about that. Um It's talking about kind of the chest is clear, there's no cough, they don't have a fever. So the person who is vetting or approving these scans might look at this and say, why are we, why are we doing this? Chest x-ray? It doesn't sound like it's actually um, something that's required. So we'll look at another example as well. So this is the same patient. And they've tried again, they're saying routine admission, chest x-ray because that's really what they've been told. I need to get a chest x-ray as routine on admission. And once again, this is rejected. So does anyone want to have a go at considering why this would be rejected and maybe even what we'd like to do instead. So often it is quite standard practice for patients who come in with a neck or femur fracture to have a chest x-ray. Uh The reason that we do this, I guess is because patients, there's lots of different things that can cause people to fall. Um and it's important to kind of rule out the different causes. So in some trusts, the geriatricians like to kind of dot all the I's and cross all the Ts and make sure that we've checked for any, for example, uh a chest pathology or uh so maybe a chest infection or something like that and you might not have the overt signs. So it's worth kind of phrasing it in a way that really explains why you want to look at it. So you're looking for a chest x-ray in case there's any um signs on the chest that might have contributed to the fall. So maybe there is a um a chest infection or maybe a chest lesion. But it's important that you're phrasing in a way that makes it seem like you think there could be something there. So if you're saying there's no cough, there's no fever, then the person who's receiving that request will be very confused as to why you're asking it. So it's almost like selling your point of view, explaining why you really would like this chest x-ray. So routine admission, chest x-ray, they're not gonna be very happy with that. Um because the chest x-ray shouldn't really be something routine without an explanation as to why. So hopefully that gives a bit of an example of how to kind of phrase your scan. So a good thing to be a good thing to write would be 98 year old female admitted with right neck of femur fracture, chest x-ray for query, um chest pathology contribute con contributing factor to fall something like that might be a uh more likely. And if you did see any signs, maybe they had they were um desaturating or had had low oxygen levels, that would also be something worth popping in on your request. So all of the pertinent findings that back up the importance of having a chest x-ray. So why your order is rejected? There are many different reasons that might be. So sometimes let's say you have a patient come in with a cough, you order a chest x-ray, but then they actually have, um, a high d-dimer level which suggests that they might have clot. And then you decide to order a ct of the chest to check for a blood clot on the lungs. They'll probably cancel your chest x-ray because those scans are overlapping, the same area is going to be looked at. So sometimes if there's an overlap in the imaging, they will reject it. If the radiographer or the radiologist thinks it's not the appropriate investigation, it's not the best investigation to look for what you want. They will also reject it and sometimes the patients will refuse to go for the scan. Often we might order scans on patients and not let them know. So it's important to kind of just go and bob your head in and let the patient know. Ok, we've ordered this scan, so you'll be taken down for it to make sure that that doesn't happen. Um because it does happen more more commonly than you think some patients might also have a bit of anxiety around it, particularly things like an MRI scan. So it might be important to have a chat with them about it, explain what the scan entails. Um And that might be able to kind of allay some anxiety. Um Also, it's worth checking how the patient mobilizes do they need to be taken down on a bed, on a chair on a stretcher just to see, um, to make sure that you're ordering that correctly when you're doing it on the system. And if a patient is really very poorly or they're attached to lots of tubing, you might bring the x-ray, for example, to you. So have the portable x-ray. So vetting of scans, this is basically getting it approved by the radiologist. Some scans need vetting others don't. So I think when you start to trust it's worth asking. Oh, do CT heads need vetting here. Does CT Abdo Pelvis need vetting here? Because at some trusts, the requests can just pretty much go through. Uh other trusts you need to ring up and discuss it with the radiologist. Otherwise there's no chance for it going through. So just ask your colleagues and they'll be able to support you. Um again, so a bit like those previous ones, we were looking at the chest x-ray, they what probably call an unconvincing request. It didn't seem like there was really any reason that we would be doing this scan. Um and then also inappropriately prepared. So some scans need uh the patient to take some contrast um via the mouth or not eat or drink for a while. Um So it's important that you find out all the information and prepare the patient appropriately to preten prevent rejections because if the scans are rejected, sometimes you might not be told. So you might need to ring up and find out why? But all of this delays the patient care and also adds more jobs to your, to your um very long list of jobs. So it's important as we say to, to get the right right. Things accepted the first time. So another meter if you guys are still awake for it, and I want you to think about why referrals might be rejected. So imagine you're ringing somebody up and maybe using your SB a method, why might people reject a referral? They're not gonna come to see the patient like you want them to. So have a little think you can also pop it in the chat box if you'd like to. So some examples might be maybe you're referring to the, the wrong person, maybe there's somebody else who might be better. Um you might be referring to an one, but actually it should be a registrar or maybe it should be a consultant. Potentially the timing is inappropriate that on uh a reduced staffing level because it's the evening or the night time and they think that it might be better referred to the day team. Um Maybe the referral is inappropriate. They feel that actually it's not really their responsibility to come and review a certain issue. If they feel that actually the team that's looking after the patient might be able to do it themselves. Sometimes if you don't structure your referral properly and you don't really highlight the pertinent findings, they might be lost in, in kind of translation. And so even though you might have an appropriate referral, if you don't structure it, well, if you're not organized in the delivery, sometimes it might not be accepted. So that's why it's really crucial to use that SB a structure so that they can see that you know what you're talking about. Um And that it's a sensible referral and that they should pay attention to what you're saying. Um And also when these people are busy and multitasking, you're able to get those that key patient information across um as quickly as you can and in the most effective way. So if you do get a referral rejected or you get a scan rejected, it's important to clarify why. Um So asking why it was rejected and maybe what you should do if they're saying no. Is there somebody else that you can ask? Is there a more appropriate person? Is there a more appropriate level of person? Um I think it's worth taking your time when you're on the phone to just think about the next steps and you can ask the person on the other end of the phone that as well. Uh What you don't want to do is to just get stressed out and say, oh, ok, that's fine. And then put the phone down and then think, oh gosh, I should have asked them actually, what should I do? And if the patient gets sicker, should I call them back and how sick do they have to be? Because maybe they say, oh, no, they're not, they're not poorly enough, but maybe you might want to know what change in conditions would warrant a re referral. Like when should I call you back? When do you want, when do you want to find out? Um, and you can also ask them, yeah, tasks that you should do in the meantime. Um, and anyone else that you should involve or speak to, you can also ask for a bit of feedback. If they seem to be a bit unhappy with your referral, you can ask them kind of politely. Ok, I I feel like maybe I could improve on this, this referral. Do you mind giving me some pointers? Um Some people might be a bit busy but it's worth asking. Um If you feel it could be helpful and even if the referral is rejected, if it's something you've been asked to do by senior, it is worth documenting the discussion. Um And you can make sure that you get the the grade of the person you're talking to ideally their name and just so that you can pop it all in the notes. So everyone's aware of the discussions that have been had and the teams that have been involved, even if it is rejected and they're not happy to come to review your patient, for example, for whatever reason, but it does happen from time to time. So um it's something that's important to talk to your own colleagues about. Um And also you can take it back to your senior and say, look, they weren't happy for whatever reasons and sometimes the seniors might then support you and they might do a senior to senior referral. So now we're gonna flip it to you taking referrals. So this might be over the phone, maybe you're receiving bleeps a bit like what we were um learning about last week. Uh It might be taking handover from your colleagues. So we'll have a look at some examples. So this is an example of a bleep. You've got your QR code here to have a go at. So um you've got Ble saying hello doctor, my patient in bed eight has a new score of six, please. Could you review them? What are you gonna say on the telephone? What are the information would you like? You can pop it in the chat as well or would you be happy and just say yes? Ok. Fabulous. I'll I'll come to review straight away. What information would you like to ask? So I'll just wait a couple of minutes. So hopefully you can all access the meantime, meter by the QR code or the code in the top right corner. So I think something that's a really important thing to learn when you do start foundation and, and progress through foundation is to really get as much information as you can when you're taking calls like this, so that you can really appropriately um prioritize your workload because it's likely that you'll have lots of other jobs on your list. And this won't be the only one. So you need to work out who is, which patient is gonna be your priority or which job is going to be your priority. So here, we don't actually know who the patient is. We know the bed number, but because the per the member of staff is working on one ward, it's their ward. They often know how many wards you're covering, particularly on an evening or a night time. So they might assume that, you know exactly who bed eight is, they might assume that you've been looking after them previously. They might not know that actually you don't know this patient at all and you may never worked on the ward before. So you can politely ask, could you just let me know the patient's name, the patient's number you can ask also, um, which ward they're on? Um, excellent. So we've got in the chat. So what is your main concern? I really like that. That's excellent. It's really important to actually find out what that person's worried about. You might get some referrals where you're not quite sure what they're getting at and they're telling you things that don't seem that worrying, but they sound worried. So it's really important just to ask, say, look, you sound quite worried. Can you tell me exactly what you're worried about or what is your main concern here? And then often that will be able to kind of reveal what is the, the true kind of root of the issue and what's been done so far? Excellent. So name of the patient for the for their admission. Good. Maybe they've had some procedures. Also, we've got a single new score here of six. So often I know particularly when I work during COVID, all of the patients had new scores that were kind of in through the roof, but they've been on those new scores kind of all day and it was very stable and it wouldn't necessarily warrant a new review because they might be doing just fine how they were doing maybe two hours ago when they last had a doctor review. So it might be important to ask them, what was their news previously? What's it gone up or down from? Maybe a new score of six is an improvement. You can also ask them, what are they scoring for? So the new score is made up of lots of different metrics. So BP, oxygen saturation, heart rate, respiratory rate, et cetera temperature. So ask what are the scores for? So you do actually get a new score of one with a normal oxygen saturation in in some places. So an oxygen saturation of 95 and 94 can give you a new score of one even though that's technically normal. So it is important to double check. Um Excellent. So thank you so much for contributing in the chat. It might be important also to ask who's calling? Are you one of the nurses on the ward? Are you one of the doctors on the ward? Um Getting the patient details. Where are they, the reason for their admission and history of presenting complaint may be any past medical history. And as you said perfectly. So what is their main concern? It's also worth clarifying their expectations. So what is it that you'd like from me and just letting them know what your plan is, you could say? Ok, that sounds thank you so much for calling me and you've done all the right things you can ask them to do things for you. Please. Could you do another set of s please could hang some fluids. I'm gonna prescribe them. Um But they're saying, ok, I've actually got to review three patients in the A&E or three other sick patients. So it'll probably be about an hour until I get to you. Um And maybe let them know, oh, the outreach team will be able to help if, if, if, if you need anything that time because realistically this is what my workload is like. Um So I think it's important to those expectations because if they're expecting you, the patient might not be that poorly compared to some of the other patients you're looking after, but if they're expecting you to come straight away because you've agreed to come, then you might just get bleeped again and again and again and that will just interrupt you and slow you down. So let them know what your workload is like and let them know. Ok, I think I'll be able to come and review the patient within the next hour. Um, if that's ok with you so that all of the expectations, their expectations and your expectations are are the same because that can often cause some, some issues. So, yeah, really good. So we've got another one here. So this is a bit different. Let's say you're in your evening handover. So you're the evening patient doctor and you're receiving some jobs from different day doctors covering four wards and this is one of the ward doctors, they'll say hi. I've just got one more job to hand over, please. Could you chase the bloods for bed? 10? Um, the initials are A B and they're on the Nightingale Ward. Does that sound? All right. Do you think is there anything else you'd want to ask for? So you can pop it in the chat or you can pop it on the, on the me? What do you think? Is this, is this enough information? Do we want any more information? So this is quite a common, um type of handover that you might receive. Is there anything else you'd want to, you'd want to know. So we've got the details of the patient. You might want to get a bit more details because patients can move wards quite a lot. Um So sometimes even with the initials, it might not be enough and it might be a bit of a night nightmare tracking them down. Um Although this sounds like a small job, you don't know what's happened to this patient. You don't know why we're doing bloods. You also don't know why we're doing bloods out of hours. So maybe this patient's had a really catastrophic um G I bleed, maybe they've got varices and they've had several blood transfusions and this is the HB the hemoglobin check and you maybe need to act on this really good. So someone said here, so which bloods and is it of any concern? Excellent. Why are the bloods taken really good? And you also need to make your life easy if it's abnormal, who do I discuss with? What do you want me to do? So they shouldn't be doing routine bloods out of hours. Um So that's something that's worth worth noting. Um And if they have been done, they will obviously need checking because they could be abnormal, but you need to really nail down. Why are we doing these bloods? What is the concern? What are you worried about? Are you worried? There's a low hb the potassium's high, maybe they're on treatment for hyperkalemia, high potassium and if it's and you need to be acting on it. So the more information you ask at handover, the easier you make your life later because you know what the plan is and you know what they want you to do and then knowing a bit of the background as a patient can also really help you when you need to escalate or discuss with somebody else. It's also worth check, checking that the bloods have actually been taken. Um People might say, oh yeah, the bloods, I I've asked someone to do the bloods but it's very different if the bloods have actually been done or not. Um So it's worth it. Have they been collected? Have they been sent to the lab? When were they done? Um because often you might be asked to chase the bloods and then when you go and check a few hours into your shift, you realize actually they've never been taken and you don't know if it's imperative that they're done in the evening and then you just have to do them anyway because you don't know if they really have to be done or not. So worth asking all of those, they sound a bit panty the questions, but it's worth asking them. So yeah, excellent. So as as you said, background of the patient, the reason for admission and asking if the bloods have actually been done, have they been sent? And then why are they taken? Why are they concerned and what action should you do? Should you escalate or inform also, like particularly with imaging, there might be a CT head that's been requested. Does it need to happen overnight? And has it been vetted or does it need vetting? Because again, you might be the one who has to do that, so it's worth checking, never assume that anything has been done. And so when you're asking questions, essentially, just think about the SB a think about information, you'd be giving someone else to make sure that you're getting all of that information from the person talking to you. So who's calling you, who's handing over to you? What are the patient details? The reason for admission, the trend in the observations, you might want to know what is the day team's plan? What is the kind of the general plan for the patient? Um And if you sense any mismatch between what the person's saying, if you think it doesn't sound that concerning, but their tone sounds concerned, you can really delve into it. Um And really ask them exactly why it is that they're bringing you. So here's just a slide. I wanted to pop up here. Um about um, the civility Saves Lives campaign. So sometimes you might be really busy, you might be receiving calls that you find quite unhelpful, they're really lacking in information, they might not be organized. And when you're very tired, it can be quite tempting to maybe get a bit annoyed at the person over the phone or get a bit cross with them for not giving you the information you need. But it's important if you're feeling like that just to take a minute and to be polite to the people on the other end of the phone. Sadly, I'm sure a lot of people have experienced being on the receiving end of someone not being very nice on the phone and it can have a real knock on effect on the, the people working within the NHS and also on the patients. So it's really important this in mind and, and to check yourself if you're finding yourself getting tired and getting grumpy, um on the telephone, um, it's something that you think is very obvious, but when you are quite tired, um, some of you may be able to relate that you can get a little bit snappier than you'd otherwise like to be. So, finally, I wanted to come on to a really important topic. So being able to raise your concerns, um which is something that is actually easier said than done. So I've just got a little multiple choice question. You can pop your answer that you think it is in the chat or you can go on the meter. Um, whichever's easiest, it's obviously a bit of a subjective one. But which do you think, which, which of these sentences is most likely to get the attention of your registrar and make them kind of come and do you, that you want them to do, which would, which would stand out most, I guess there's no definite right answer here because it's so subjective. OK, we've had some people putting in answers. So as I say, there's no no wrong answer. Um Just what you guys think so so far everybody has gone for b so I'm concerned about this patient safety and excellent. I, I'd agree with that as well. I think some of the other information can be important. Um But this is something that is quite hard to ignore if somebody is saying this to you. So this is kind of pulled from this cus tool, which is a, a model that's designed to help people to raise concerns. So if you're talking to uh somebody on the telephone or registrar and they're just telling you they're really busy, they have to go to theater, they'll talk to you later, but you are actually just very worried about the patient. You can say, look, I'm really sorry. Um I actually feel very uncomfortable managing this patient at my level. I'm really concerned about the patient's safety and I'd really appreciate it if you could. Um This one I think is a little bit hard to say sometimes, but you can ask them, I'd really appreciate if you could, you could stop what you're doing so that you can come to, to review this patient because I am very worried about their safety and you can do the cus without the final s if you feel it's a little bit too brave. Um But putting these words in so mentioning patient safety, mentioning that you feel uncomfortable and that you are concerned, just adding these few words can really help to raise the, the concern in your voice and make the other person actually stop, stop what they're doing and have a little think and maybe reconsider coming, coming to help you out because everybody can be very busy and have a lot on their plate. So it's important that you're able to clearly articulate your worry um and get that across. So hopefully you can kind of remember this and bear this in mind when you're in a situation where maybe you feel like you're not being listened to as, as well as you'd like because perhaps they're very busy and they're doing lots of other things. Um And hopefully you can, you can use this as well at the start of your sr A. So you can use that I'd recommend in the s when you're starting. So very concerned about this patient's safety. I don't feel comfortable managing them because XYZ and then you can do the rest of the sr I think that these are good terms to use in your headline to really get their attention. So I've just popped on the screen some helpful resources. Um So the top one is just a kind of a more in depth um kind of going through the sar giving some examples that's quite helpful. One to look at um is uh a useful website that has a referral cheat sheet on it. So you can download this cheat sheet. And it basically tells you about all of the different special respiratory radiology and pediatrics. And they've got a little box for each which just explains the kind of information that they might be asking you and they might look for to really help you prepare. I think the more prepared you are for referrals and the more you've read up on the patient and almost done a quick kind of revision of the patient, the more likely you are to have a constructive conversation and kind of get that job ticked off. Um And then finally, there's um another resource which is going through the cus tool and giving some examples of how to use it. Um So you might find those helpful to have a look at after today's session. So finally with about 10 minutes or so to go. Um I'd like to thank you all for joining today and hopefully you've um taken something away from today's session. Um If you have any questions at all, uh do feel free to pop them in the chats or to pop in the um I'd be very happy to answer them. Um And thank you all very much for listening. Thank you very much Molly. Um So that's the end of the lecture. Uh We'd really appreciate if you could fill out the feedback form, which I've just popped in the chat. Um If you complete it, you'll receive a certificate for attendance. Uh Once again, we've got more sessions lined up for you guys. So please make sure to register for those as well. Um But otherwise, thank you for joining us and we hope to see you at the next lecture happening next Tuesday at the same time. Um And I'm just going to pop the registration link for the next session into the chat uh which should hopefully make it easier for you guys. Great and uh Molly just hang around for a bit uh in case anyone has any questions. Yeah, happy to answer any questions anyone might have about the talk or anything else.