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Um it's almost four past four. I think we can start. So again. Hello, my name is Yasin. I'm a um I'm a Turkish doctor working in Birmingham Sabe Hospital. And today I ha I also have my colleague, Doctor J and there um she's working in Heartlands in Birmingham as well. Today, we are going to talk and talk sbar and talk. We were talking about the effective referrals and telephone calls. So it was, it was a nightmare of me for for for the first three months maybe to answer the calls to call someone for second opinion. So I was just like, oh, I should, I knew that I should follow the sbar, but practically it was difficult to do it for me. So today we're gonna talk about it and talk about the how to do factory referrals. Um So objectives of the sting as you will be able to recognize the importance of communication and you will be able to um extract the relevant information for SBAR and identify the demonstrate of the steps of the SBAR. So um it will take approximately 30 to 40 minutes and we will be asking some questions in the beginning and after we're gonna uh we're gonna show you some videos examples and also we're gonna do uh a practice with John. I, and we'll ask you to give us a feedback about it. OK. So let's start uh after that part, I will uh I will ask Doctor John I to um go further and have the presentation. So she is also working in Hartle, as I mentioned and she's uh um she's right now working in uh a good medic, a good medical unit, isn't it? I just, just so you can help me please about it because he has just changed his rotation. We all have change in rotations. Yes, thank you. Thank you very much for a lovely introduction. So I worked in acute medicine for a year now. Uh I'm currently in elderly medicine, uh elderly care. Uh but e either way you, you use SBAR for all the consultations and everything. Uh Before we start uh our session, we would appreciate if you guys could uh answer shortly to this poll. So we know our how is uh our audience? Uh You can either scan that QR code or if you're joining from your phone, you can go to slider.com and enter that number at the bottom. If that's easier, I'll wait a couple of minutes while you guys doing that. Yeah. Uh We have some people looking for a job, have been working in NHS for a while. Um We would love your contribution. Uh at the end of the session during the practices. If you please, some people that just started working in NHS recently started it 38. Actually, it's a good evidence. I hope you all, all of you guys will be, will be, will find this presentation helpful today. All right, I think we can, we can continue. Yeah, thank you so much. So, let's talk about importance of communication. Uh As you guys know doc being a doctor as a profession, we work very closely with people, either this is patients or it is our own colleagues. We work with people and communication is an important keystone of our old work. Um And it is very important for us to convey this information and tasks appropriately, whether this is uh seeking a second opinion, escalating our patients or handing over the tasks. Uh It's important to have a clear communication uh throughout. So um being in the UK as you guys know, it's, it's a very multicultural uh co uh country. We all come from strange countries, strange cultures, strange systems and all of these uh add barriers to this communication, even even if you're born and raised here. Um some different factors come in like uh either the profession, maybe um the communication between doctors and nurses or other healthcare professionals or the hierarchy, maybe you're talking with your senior and um you might feel shy, you might feel com incompetent. Uh All these are barriers to communication, just simply uh we might have different styles of communication and um inadequate and verbal and written communication is recognized as being the most common root cause of serious errors, both clinically and organizationally. That's why it's uh very important to have a clear communication. Communication is uh more effective in teams where there have been standardized communication structures in place. That's what we're gonna talk about today. Uh One of these, what these things, these structures was new scoring. It's short for national early warning score. Maybe some of you uh probably heard about it. Um This new scoring actually designed as a common language between doctors and nurses uh to explain what it is. It is basically they check for the patient's vitals and every range of vital give you a score. And if the total score is higher than uh a certain point, nurses needs to escalate these patients to doctors because they're in, they're at more risk of rapid deterioration. Basically. Uh before this scoring, they didn't know like this patient spike the temperature. Do I need to tell doctor about it? This patient's BP is 110/80. Do I need to tell about, tell the doctor about it? So there was a lot of inappropriate referrals or inappropriate nonreferral. So to say uh with this scoring um as a common language, uh this eliminated most of these communication errors. Now we can um have a a better communication with nurses. Another uh example of this is a, this is what we are going to talk about today. SBAR is a shared mental model around all patients situations. It is a systematic way to explain your patient. Um With this systematic way, actually, we aim to overcome some, at least some of those uh communication barriers we just talked about. So what does uh could you go to the previous one? Thanks. Uh what does Sbar stands for? So um Yasin uh will explain all of these in detail but to go shortly, s stands for situation, just who you are, where you are. What's wrong with the patient. B stands for background. Well, patients general background and admission details, A stands for assessment. That's your examination and tests and R stands for recommendation. That's your recommendation to the other person. That's your expectation. Um Yeah, we can go to the next one. So what does SBAR helps us? It takes the uncertainty out of the important communications sometimes when you talk with someone, um it can cause some assumptions weakness, especially if this is some someone senior you're talking to. Um you might feel shy to ask them uh directly to come and review the patient or do this do that. SBAR gets rid of all of that and um allows us a clear communication. Uh Basically, it just prevents the hit and miss process of hinting and hoping there is no hoping in Sbar because we do the clear communication, it can be used very effectively to escalate all the problems and uh that requires immediate attention and facilitate efficient handover. But it doesn't even have to be immediate. So this tool can be used in any scenario that uh any scenario at any stage of the patient's journey. Um It can be urgent and non urgent communications. It can be written, uh It can be consisted of the GP letters uh to consultations to other specialization. Um Basically anything, any situation that you need to talk about a patient, you can do it with Sbar. So now yes and will explain us. Um What are the as bars? Hello again. Um So we mentioned about the SBAR S stands for situation B stands for background, A for A for um assessment and R for recommendations. But what are they actually means I will be explaining it to you with some examples and then in the end, we'll show you uh videos about it. OK. So as for is starting with situation, so situation means you need to tell who are you first of all? Where are you calling from? Cause the people who you are talking with doesn't know where are you calling or where is this patient? In? Then after you give the details of the patient, it depends on the who you are talking with. Again, you can tell the bad number, but it's always better to give the patient's name and double check and you can also give the P ID numbers. Then after, before going to details in part, you can just tell why are you calling? Just describe your concerns in a, in a very short way. Then after you'll did, you will be telling it it, you will be telling it in details. For example, you can say hello, this is doctor a calling from 5.8 Infection Disease Ward. So I'm calling for Missus Taylor in two in bed 25. He has just became suddenly shortness of breath and I'm a bit concerned about it. Then what you have done is in with my example, you identify yourself, you identify the patient and then you describe your concern. So the per pe people know that there is a one patient getting suddenly shortness of breath. So then you start going further you and you can also explain um your um respiration rate, heart rate, which are in this case, in the, in this, in this example, which is um uh um which is increased and the numbers has changed. So you can tell in this part as well. But most of the time we tend to tell details about the patient in assessment. So let's go to the background background is stands for what, what is this patient is in this hospital? And what is the medical history of this patient? It stands for this actually. So you're telling that you might tell that this lady is this, this patient is here for community echo chest infection and she has been on IV antibiotics for a while for three days. And now actually, until now she was doing well, but we don't know what happened. She suddenly become shortness of breath in in this case. And then you need to mention about the background history of the patients. In this case, it says that she is normally fit and well and independent. It's OK. You might need to give um more details. If your patient has some background history, she might have hypertension, diabetes and other medical conditions. But the question is actually, do you think that you need to mention every past medical history, every medical conditions? Like let's say that Missus Taylor has cataract. Do you think guys we need to mention that this patient has cataract or do we need to mention that this patient has also arthritis? Yeah, you don't need to mention because if it is not relevant as far as a quick communication, actually, it doesn't, it doesn't take too long time. Um So you, you, you don't, you don't mention about all the medical clerking details like past medical history. Uh If it's not relevant, you don't mention osteoarthritis or cataract. If it's not relevant, you don't have to mention about all the medications patient is taking or patient is taking vitamin B12 every weekly. You don't need to mention it if it is not relevant. Relevant. Ok. And you in the background. Just to, just to make a recap, you give the the reason of the patient's admission to hospital which might be related with recent problem or which might not be re uh related with your call. And then also you need to mention about the patient's past medical history which is background. OK. Then we go to the assessment part. Assessment part is actually vital signs, clinical impression, your exa examination findings, your um blood results. Then you can also mention scan results, ct result, chest X ray. All those things can be mentioned in the assessment part. So what I have done is so call them, introduce myself, introduce the patient. Then I called and then I gave the information about why this patient is hospital. And then I came to the assessment part. This patient had a shortness of breath and I reviewed with the patient, what I have done, I will be telling an assessment part. The other question should I mention about all the blood results or all the examination findings? No, it's always better to mention about the positive findings and ne and and significant negative findings which might um which might help other people to exclude some other diagnosis. OK. So in that has been part we're mentioning and talking about all these details. Let's go with this case, we have another cases as well. But in this case, Mister Taylor's vital signs have been stable from admission, but he deteriorated suddenly. So you're giving more information about how it has happened. So she's complaining of chest pain and there appears to be blood in her sputum. There, this is example for nurse, but you as a doctor, if you are calling someone for second opinion, you will be having more information than it. For example, you can tell about this patient. Oh yeah, I have sent some blood which showed troponin less than four. but it showed like the dimer is 487. OK? It's positive. Then you go for examination on the examination chest was clear. But I also noticed some uh swelling and redness in, in patients legs, in, in, in, in his, in his leg, in her legs. OK? And then you can also mention about I checked the medications cos it's always better to have knowledge about the patient. You can also not also you need to also mention about this patient is not on VT E prophylaxis. So it might give more idea. So it's you telling everything relevant, but you don't need to tell which antibiotic this patient is taking. So it always depends on the question you're asking or or and also it also depends on the which um problem you're dealing with. So let's say you call, let's say that you're calling a Infection disease consultant and asking for advice for antibiotics. Of course, you need to mention about the allergies in background and you need to also mention about the examination findings and assessment part. But in this case, for example, we don't need to mention about the allergies. So making it a bit um relevant to make it a bit relevant. Ok. So in the assessment, what we have done, we have explained our examination findings, blood results, skin findings um and also vital signs. Ok. So and then you're going to recommendation, recommendation is actually your recommendation as a people who, who are calling, it's not that it's not a recommendation of the people who you're calling to. You're not asking for recommendation, you are giving your recommendation. So I'll make a bit clear. You're calling your, let's say that you're calling your consultant, you're calling your registrar and you're on the ward by yourself for in the in the night shift. Ok? You call your registrar for this case, you explained what's been going on. The patient has been deteriorating. You, you explained your findings as well, but in your recommendation, it's not, this part is not the things that you're gonna get from your registrar. This is what you're gonna tell to your registrar. My recommendation. Would that be ok if you come and review the patient or do you want me to do anything else? Do you want me to do this? And also you can ask if in if in this case, you can ask, you can ask for the for review and other things like that. But if it's a handover that you're handing over, handing a patient over to your um to your colleague. Let's say that it's, it's, it's, it's in the evening shift, you are giving handover to night shift team. Ok? And then what you would, your recommendation would be for this patient? You might say that ok, I think this might, this patient might have a pe so that would be great if you can arrange a CTPA for this patient and I had no time to start the treatment dose of an extra. Would that be ok if you can start uh um treatment dose of an extra? So this is your recommendation, either to your colleague or it might be your senior as well or to the nurses. Ok. So this is the sbar. What I what is the ideal sbar, the ideal sbar is the people who you are talking with needs to read back, needs to re read back. So to make sure that everything has been understood, people need to give you more, give you some information back to, you need to give the details of the patient that you have told and need to that these, these people who you're talking with need to tell you from the back from the beginning like, ok, you have a one patient, 65 years old patient in and ward 25 and blah, blah. Um this patient is coming, coming with a um pneumonia pneumonia and he she he sudden she suddenly deteriorated has a headache, shortness of breath, am I right? And double checking with you and then telling you that you find this one and the blood results show that one. Am I right? So this patient needs to double check it with you to um to not to miss any anything. This is the ideal sbar. So I'm gonna show you some examples. We have three different just minutes of videos, 1.5 minutes of videos and then we're gonna um talk about um we're gonna do a practice together. So this is a great examination. I hope you guys all can hear it. Let me know uh if you can. No, no we can't hear. Can you hear? No, we cannot. Ok. So um I'm not sure how can we arrange it? Let me find it. I will do it quickly. Give me some two minutes. Mm It's not about getting rid. Yeah. Oh it started now. I'm sorry, Sulfa. Um So it's gonna start now. I hope you can hear now cos I'm gonna open up with my phone. Sorry for it. We should have done. Mind it. I know um practice. All right, the emergency moment. Can you please currently on? That's what understood very well. Maybe change the place of. Ok, so the story is she was at home and she tripped over the rug and fell on her right hand side. She didn't have any chest pain or shortness of breath. Or dizziness before she fell. And uh, she hasn't complained of any other injury. She has got a background of arthritis in both hips and she is awaiting a right sided hip replacement. Ok. She's got a new score of two with saturations at 94% and a pulse of 92. She's got a shortened, externally rotated right leg that would fit with a fractured neck of femur and that was confirmed on X ray. She hasn't got any other significant injury. So I was expecting her to be admitted under the care of orthopedics. If that's all right, that's not a problem. Can I ask what uh analgesia has she had? Oh, yes. She's uh just getting a Fascia Aaca block at the moment. Brilliant. Thank you. I can come and review her shortly. Brilliant. Do you know how long you'll be? I'm just reviewing a patient on the ward. I should be down in 15 minutes or so. Ok. So you'll accept the patient and you'll come and review it about a quarter of an hour. Yes, that's not a problem. Brilliant. Thank you. I hope you were able to hear um because we heard we did. That's good. Perfect. Now that uh consultant on the other hand, ask some questions, I want to just have a gentle reminder that guys before calling someone, just make sure you know, the patient have a read and be ready for any possible questions. It's always better to have the, all the details of the patient in front of you. It might help you to find the details if you don't know. Um, we have another example. I'm sorry. Mm. So we have it in here. Just need to find it quickly again. Mhm. Bye. Hi, Doctor Feldman. Ok, I'll start it now, let me know if you can't hear it. Hi, Doctor Feldman. Yes. Uh, this is Amy from Two West. I've been taking care of, Miss. Well, she's an 82 year old woman. She was admitted three days ago with DVT. Uh, she's on Heparin, telemetry and oxygen. She's been alert and pleasant with no problems other than urinary retention and she has a foley in place but tonight she appeared confused. Um, she's awake and oriented to person but she thinks that she's at her aunt's house and that Ronald Reagan is president. Yeah. Well, no, II, checked with her nurse from the last few nights and confirmed that she doesn't sun down and she's normally very sharp. Her heart rate has increased to 110. Her BP is down to 1 10/60. Yeah. Her systolic usually runs 1 50 minutes. Uh, yes. Uh, her temperature is 37 °C. She looks pale but not uncomfortable. Her coag studies are within the parameters and her blood gas is normal. All other a labs are normal but she's not putting out much urine and it looks cloudy to me. I'm worried about her I think she needs to be seen. You want me to order some labs, maybe send her urine for culture. Yes, it sounds like she could be getting septic, send a urinalysis with culture chemistries and a CBC. Thanks for calling. I'm on my way but I need to know if there are any changes immediately. So that was another example. I I'm wondering uh what you guys thought of that example? Any comments? Mhm How did you find that? So one thing, maybe I can say they, they didn't recap in the, in the, in the, in the, at the end of the conversation. So um sometimes you need that guys cause um you know that in the UK there are like 100s of accents I would say. So it's difficult to understand what are they saying exactly. It's always better to double check at the end of the conversation or during the conversation. So it's always better to give a recap um um at the end of the conversation. Mhm. Uh I also noticed maybe, well, it's a very small issue but maybe she was giving some irrelevant details as well. For example, they're, they're thinking about uti causing confusion in this lady. Uh Why would coagulation studies be relevant? She, she already said all bloods are OK. But hi doctor. Yeah, and also mentioned about that. Yeah, we have the another example in here. Just let me to start it gonna start. Now let me know if You can hear Pines Care Center. I'm calling you about Mrs. Just need to do one more time. Hi, Doctor Flores. This is Liz James from the Shady Pines Care Center. I'm calling you about Missus Mary Smith. 88 years old has had a change in her condition. She has a new onset of confusion, has developed a cough and she didn't eat much today. 25% of breakfast, 50% of lunch, 75% of dinner and she's not taking on any extra fluids. Missus Smith has type two diabetes, arthritis, osteoporosis, cataracts, stress, incontinence and mild cognitive impairment. She walks with a four point cane and is hard of hearing. She is lethargic but responsive to simple verbal commands. She doesn't normally exhibit impaired judgment, but last night was found wandering in other residents rooms, looking for her bed, her blood sugars and vitals are normal. However, she has been running a temp of 99 since 11 this morning. She has a dry cough and on auscultation of her lungs. She has some bronchi in the right base and her urine looked cloudy. I am wondering if she's starting with a uti or respiratory infection. I think she's stable to stay here with us. But should we get a urine chest X ray or other lab work? Yeah, that was another example. But I think in this example, there are some points needs to be improved. Did anyone catch anything like what do you think about, about this, um, example, I can see the common parts but, um, generally if you can see if anyone type anything, I'll tell you. Thank you. Oh, so again, I think, um, so, oh, so, yeah, someone says, uh, some medical histories are unnecessary. I completely agree. I think so. Yeah, she mentioned about osteoarthritis cataracts. Yeah, are not relevant at all. But what do you think about, um, she, she also mentioned about cognitive impairment. Do you think that is it related because it sounds like any ideas about it? Um So it doesn't sound, is there an answer? No, no, no, fine. So it doesn't sounds like it's relevant to this presentation, but actually it's relevant cause in the UK there is a term of um sealing of care which means like how much are we gonna treat this patient? Are we gonna do CPR are we gonna take her or him to the it? So we need to decide about the sea of the care. So for that, it's important to know the patient's cognitive, cognitive abilities. So it will be, it will be OK to mention about um Alzheimer or cognitive impairment. Yeah. Also mentions it, it could be relevant if it is worse than her baseline. Yeah. Yeah, that's, that's also another reason to need to be that, that we need to mention that makes us need to mention um Yeah, we have a practice to do with um to do with you. Or any of you wants to do. We would like to make it uh interactive. If you want guys, anyone wants to have a go and do it. One people will be um ward covering sho in acute medical unit and the other people will be on the call um will be the medical medical registrar. So the details of the patient is here. Uh what we have done, what is this patient is coming from coming with? I will be explaining to you and we'll be uh quickly having a look at it and then we put a bunch of information. Yeah, all these informations are not related uh but some of them are relevant so you can have a look and decide and uh let's see any one month you have a go, we'll let you guys have a read for a couple of minutes just so if anyone doesn't know troponin and D dimer are both negative in according to our hospital's laboratory. Yeah, heart score is a little bit, heart score is high uh for this patient. And also, well as if you don't, if you, if you, if no one wants to do, of course, we're gonna do it with John. I we're gonna do practice. Um but that would be great if anyone wants to have like a OK. All right, we can start if you want. I Yeah, sure, sure. Do you want to be the or the I can be the? Ok. Ok, so I'm calling you now. Hello. Hi. Hello. Uh actually before we start to calling each other, sorry, let's have a look to the patient's details quickly. It's, it's good for me as well and it will be good for you to understand which details needs to be mentioned. So we have a patient, it's a long, long sentences. It's it's difficult to catch up. So we have a patient 85 years old male, patient name is John Doe. Um she has a background history of type two diabetes, mellitus hypertension hyperlipidemia, nonstemming before had it four years ago, let's say osteoarthritis cataracts, Sebo dermatitis, COPD. So patient has occasional alcohol intake and also uh patient is exsmoker. The patient actually admitted with infector COPD exerbation three days ago. He has treated with um these medications and also patient has ad Nr CPR in place cause 85 years old patient with a loss of background. It's OK. Makes sense. And he suddenly developed crushing central chest pain for an hour ago, uh an hour ago. Um he doesn't have any increased shortness of breath, no palpitations, no dizziness of syncope on the, on the um on the examination, I passed the examination part automatically in my mind. Um, chest sound was clear and, and heart sounds are normal. No chest wall tenderness, abdomen, soft, non tender coughs, no, and tender observations show that the saturations are 92. It's ok for COPD patient if it's retaining over 10 at some point. And heart rate is 95. BP is 1 38/88 and temperature is 36.5. We did that an E CG OK. It's great non s uh normal sinus rhythm. No S TT changes good and tr first troponin is four D dimer is 150. Heart score is five. So we gave GTN to this patient but no improvement seen and he, he sent it, we we request a chest X ray still don't have it, but blood bloods are pending and patient has a still patient is still in pain pro procedure. Mal has been administered four hours ago. So this is going to be the informations you're gonna have roughly about your patient. You can check it the notes and you can check the electronic system while you're talking on the phone and have a look and tell the details. Like I might like I'm going to do now or you can be you will be, you might be able to know all the details about your patient. Ok. Um Shall we start then? Yeah, sure. Yeah, I got the, I got the details. I got the information so I can confidently call my registrar and ask what we can do for this patient for. Ok. I'm so nervous. I'm calling my registrar. Hello. Hi. Hello. Hi, my name is Yasin. I'm one of the doctors um working in uh acute medical unit. So I have one patient to discuss with you. Is it a are you available to talk? Yeah, sure. Go on. All right, fine. Um This patient is John Doe 85 years old patient. Um she he's staying in bed 35 in um in a unit. So actually suddenly this patient developed um central chest pain. I'm a bit worried about it. Um Do you want me to tell the details of the patient like P ID numbers or do you want me to go through the, what is, what's been going on? Uh Yes, please. I'm not very familiar with the patient if you can tell me the OK. All right. So this patient is coming with actually COPD exacerbation. He came to days ago, they treated him with um nebulizers oxygen prednisoLONE. It, it's OK. But suddenly he developed a central um crushing chest pain an hour ago and he doesn't have any shortness of breath, doesn't have any palpitation. No dizziness or, and observation findings are on findings are normal as well. The saturation is 92 but it's probably normal for this patient. So we did an E CG. Um we did a troponin, we did ad dimer and it was all negative E CGE CG didn't show any S TT changes and heart score is five. Oh, actually, I forgot to mention the background of the patient. So this patient has a nonstemming history, hypertension type two diabetes, mellitus and hyperlipidemia and CO PD So my examinations, examination findings were unremarkable, but we gave GTN it didn't show any improvement and you had a chest X ray of course, but it has still waiting and other bloods are pending as well. So I could I be sure what to do more. So your first appointment is negative. Should I send another troponin? And also is there anything else that you? Yeah, that you would recommend to me? Um could be sure actually, uh what else, what else can be done? So that sounds like a good plan. Uh well done for the management until now. Uh allow me to just sum it up to make sure I got everything. So that's a, you have a 85 year old gentleman with a lot of uh vascular comorbidities. He was treated for COPD exacerbation uh currently in the hospital uh but developed a cardiac sounding chest pain an hour ago with no improvement with GTN and uh pret and you haven't found anything positive in neither an ECG or the bloods yet. But still this patient is a very high risk of uh cardiac events, isn't it? Heart score is five. So, is that right? Yeah, yeah. Thank you all the details. Yeah. Uh So obviously, we we would check the chest X ray and other blood as well if there is anything going wrong. Uh I would advise to se send a second troponin and uh repeat the ECG since patient has still ongoing pain check for any changes. Um If there is any changes in the ecg uh if second troponin is raising, if patient becomes hemodynamically stable, just inform me right away and uh discuss with the cardiac triage as well. All right. Ok. Ok. Um All right. Um Could you, could you please tell me your name and I can document it or do you want to document it? Uh Yeah, I can document myself. All right. Okie Dokie. Thank you. Thanks a lot. Thanks. Bye bye bye bye, bye bye bye. So that was the case. Um What do you think guys like what needs to be improved? What was the mistake? And mm what details you you notice and what is your feedback? I guess it was perfect. No one's commenting anything. Um The only thing I made it um intentionally. So the background. Yeah, I moved it from beginning to the end. What do you think? Is it, is it ok? If you forget it, it's ok. But ideally it needs to be mentioned in the beginning. Yeah, because it will, it will give other people to more idea about the patient patient. Yeah, the risk factors to know the risk factors from the beginning is Yeah, important. I agree. Yeah. What, what would you think like without knowing this patient had a previous non and I'm calling you with that of a chest pain. So it would change the whole management probably cause heart score will be different. Yeah, and the risk factors will be different as well. So it's important to mention. Um So let's go have a look what we have done. Uh We have a question. Yeah. Uh It's a and if asking, it's a bit irrelevant. Um I always struggle with the documentation. How would you document that correspondence? Um It's always ideal to our doctor to document that because he is telling you the things. But if it's busy time, like if they can't, he would also document it with the details of what you have discussed. Sbar you mentioned, you can mention that I discussed this patient with doctor blah, blah, who was the name and surname and, and also that you can mention about your findings, what we, what we have discussed with that uh doctor and what are the recommendations these all needs to be documented? Yeah. Uh That is something I find lacking in NHS system. There is no official uh way of consulting. Uh So what we did you discussed someone on the phone that is legally binding. Um Sometimes they ask you to document yourself and I find that quite unsafe because it could be that I didn't understand everything or, or I understood something wrongly. And it is basically me writing, I spoke with this doctor and they told me this um it also sounds like looks unprofessional on the noting as well. But if they don't, they, they are very busy to document it is um easier to uh like uh I if they're visit to document, you have to document. So what, what I do, I discussed with medical registrar on call with doctor blah, blah and they advised me this. Yeah. Um Carlos says whenever there was a referral and someone recommended a plan, I never know who is responsible to write that into the electronic patient records. The person who made the referral or the person who answered it. I believe it. It is supposed to be the person who answered it because they are the one giving the recommendation. It is I feel that is more appropriate. But like I said, if they're busy, someone has to document it. Yeah. So um I will just, we will just I will just quickly talk about um what we have done in this case, quick recap about it. So we gave the details. Where am I working? Why are we calling? And then we gave the details of admission and background. And after we summarize my assessment, I didn't give all the findings. I didn't mention that. Oh, chest wall is clear, heart sounds are normal. No chest wall tenderness you can mention about chest sounds or cause this is related with chest. You can also mention about chest wall tenderness but abdomen is soft and tender. You can also mention but soft nontender is not relevant with that case or you can say examination findings are unremarkable in the background. You don't need to mention about osteoarthritis cataract, seborrheic dermatitis. And also you can, you don't need to tell the all the observations like saturation is 92 on room a your heart rate is 95 BP is 1 38/88. This is just takes a long time and it will better to um summarize it and say the observations are stable. And then what I did is like I asked him, should, do you want to review this patient or do you want me to send the second troponin or uh what else would you recommend? So tell him my recommendations. Actually, my recommendation is like sending the second blood, but I just double checking it with my senior. And also I'm asking him to come and review. This is the recommendation part, not uh the recommendation is not the um registrar told it is not the thing that registrar told me. It's the thing that I'm asking or um telling, telling him to or her to do or tell me. Uh So the aim of sbar is going with structure but also making it very simple. So uh giving all the details, makes everything confusing, especially if the other person is not on the computer looking at it. Yeah. Um Thank you for listening to us. I will share the feedback form and also I will share example videos with you so you can watch it later. Um uh We can keep watching other things as well. So uh for this presentation, we got a lot of help from uh NHS guides. I will just uh copy the link here if anyone wants to check any further. Uh And if anyone has a question, by the way, we are happy to have your questions and we'll be sharing the videos with you. And the second video is that one. Thank you for joining us today. And we are, we are, we will, we will be happy to see your feedbacks and after the feedbacks you can, uh you can get your certificates and it can also be used for CPD points. Thank you guys. And yeah, the third one. Yeah, I'll share the third one as well. So thank you all of you guys. Thank you all. Um Next week. Yeah, let's talk about it. Next week, next week on Thursday, we have a special guest. Um She will be um uh Doctor Kasher. She will be talking about the IMT applications and how to do, how to, how to get, how to get ready for the interviews, application interviews generally. So we'll be talking about it. Um It's on, it's going to be on Thursday. Um You can check and you can register with the uh network and we'll be happy to see you. Uh We'll be happy to see you there as well. Ok. Um If you follow the network, then you will be able to um hear more from us. We'll be sending an email to you. All right. Thank you, everyone. Any other, any questions, very helpful session? Thank you. Thank you for joining us today. He we're happy for you. Thank you. Thank you. Thank you. Thank you very much. Thank you. Uh.