The Day-to-Day Running of the ACCU

ALL ADMISSIONS ARE TO BE DISCUSSED WITH THE FIRST ON CALL ACCU CONSULTANT

AT LEAST ONE AIRWAY TRAINED DOCTOR (Anaesthesia or ICM) MUST REMAIN ON 4E AT ALL TIMES

The Daily Plan (Monday to Friday)

Time Activity
08:00 Handover
4E doctor’s office
– start with the ‘MORNING DRILL’ laminated sheet
– split into team A+B
– C day trainee should be allocated to each side
– hand over each side at the same time with your consultant
4F doctor’s office
– start with the ‘MORNING DRILL’ laminated sheet
– Team C handover with consultant
Tuesdays and Thursdays Teaching will take place before handover for Teams A,B and C
09:00 Trainees begin clerking patients
– all patients are to be examined fully
10:00–13:00 Consultant ward round
14:00 L trainees arrive – one reports to each team (A,B & C)
17:30 Day consultants hand over to night consultants S day trainees go home
18:00 Evening consultant ward round
– a C day trainee should accompany each consultant
20:00 C day trainees hand over to the night trainees

The ICU nurses take routine bloods at approximately 04:00 and the results should be reviewed as soon as they are available (approximately 9am) and management adjusted accordingly.

Day Shift (C and S)

One of the C day trainees takes responsibility for co-ordinating the morning handover and carries the 1113 bleep and should be on side A. There should be another C day trainee on side B.  The S day trainees should split themselves across the teams bearing in mind the usefulness of continuity.

Late Shift (L)

The main role on the L shift is to support the day and night teams. You will find yourself doing a lot of the scans / transfers and be expected to clerk in the patients who arrive late in the day allowing the C day and night trainees to handover in peace (well that is the theory).

Night Shift (N)

After hand over you will probably find the consultants are still around – unlike other units this is normal practice so don’t be put off by it! You should liaise with the consultants before they try and go home and ensure you know who to call should you need to. You should aim to start your night round before 23:00 with the nurse in charge on your side.

Tasks to be completed before morning handover:

  • Order the x-rays
  • Complete/update patient handover document and print them out for incoming day staff
  • Add any outliers to the white board (i.e. patients you have seen that need to be flagged up for re-review etc.)
  • Familiarise yourself with all patients and present all new patients, paying attention to presenting complaint, history of presenting complaint, PMH, differential diagnosis etc.
  • Nights are often a good time to look through CRS and update any results/print out EEG/CT/MRI reports to file in the patient notes

Communication and rest periods

  • Ensure the 1113 and 45715 phones are being carried by the senior registrar
  • Ensure the 45714 phone is being carried by the HDU registrar
  • Ensure that the nurses in charge of each team know how to contact their respective registrars
  • If you leave the unit, ensure the nurses and the senior registrar knows how to get hold of you
  • If you go for some rest during a quiet period in an on call room, please give the extension number of the room to the nurse in charge of the team you are covering and the in charge registrar, sometimes the phone reception can be intermittent

All HDU admissions overnight should come through the senior ICU trainee on 4E. The trainee covering HDU overnight can go and review patients on the ward who may be suitable for HDU admission but this has to be discussed with the 1113 holder on ICU to ensure adequate cover.

Weekends

There are only two consultants at the weekend and they join the 4E handover so 4F can hand over by themselves.

Often one consultant will start and bed 1 and the other at bed 23 and the trainees can cross over at bed 15 and 31 – though this doesn’t always work / happen.

The aim is to close the 4 elective surgical beds on Saturday afternoon and reopen them again in time for elective post-operative admissions on Monday.