On-Call - Extension to Patient Lists?
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Nidhi Gupta
Jul 29, 2012, 12:21:30 PM7/29/12
to nhsha...@googlegroups.com
Dear All
This is one for hospital doctors - the on call. The 'patient list' solution was great (congratulations) and it focused on the handing over of patients.
However, as a possible extension I want to talk about the problems of new patients.
So, a typical day on call. On call means the on-call team see all new patients coming into the hospital. This includes people who might not need admission walking into the Emergency Department who require (or as the case tends to be, not-required but are referred because it is easier to refer to medicine than send someone home) to the very sick patients who need immediate help.
Patients come in one of two ways: either referred directly to the medical team by a GP or referred from A&E.
Come in at around 08:30 and take the bleep (eugh) from the night registrar and find out if there are any patients still waiting to be seen. The patient list is started for the day - this tends to either be a piece of paper on the wall which people write on or is a computer excel sheet which is dedicated or a book which has stuff written in it - all in all, very unsatisfactory.
In hospitals the medical registrar or SHO takes calls from GPs and A&E/ED for patients they want to refer. The conversation goes something like this (with some typecasting for effect):
Referrer: Hi I am so-and-so and I have a patient with chest pain, possible minor heart attack and they need a troponin (specific blood test to rule out an heart attack) in six hours
Reg/SHO: Is the pain typical, what are their risk factors?
Bleep goes off - another person calling (most likely the person sitting next to the person currently on the phone)
Referrer: Um, they had sharp chest pain on breathing in, cough...
Reg/SHO writing down the number before the bleep goes off again
Reg/SHO: Okay, okay, what's their name?
Referrer: It is a 73 year old called lskfjszkjfhajfh;g, hospital number 123456
Reg/SHO: Is that algj;gj;jigisofgj? number 456789?
Referrer: Something like that
Bleep goes off again
Reg/SHO scribbles something down and makes a mental note to put it on the computer, if there is one
Reg/SHO puts phone down
Two hours later
Nurse: Did the medics accept a lkgja;gj;a? number 789123?
Different SHO: No, not on the list, there's a atusoitutiu number 345678, but not a slkgjakgjg
Different SHO bleeps the Reg/SHO and asks if they accepted sgkjklgjf;,
Reg/SHO: oh yes (checking scrawl), um, 73 year old chest pain, trop needed in a few hours.
Different SHO: Well this guy is 65 and has a raging pneumonia and can't breathe...
Reg/SHO: Bugger, on my way
Was there ever a 73 year old? Is it a mis-diagnosis? Is there another patient out there, waiting somewhere who will not be found for another three hours? Who knows - my bleeps gone off another three times during the course of the last five minutes and I am already 18 jobs behind for the day. No time to think.
When I do have a moment to think I go to A&E and ask about this mythical 73 year old - the person who saw them? Um, a bloke. Well the day shift has already has gone home and no one really knows anything without a proper name or hospital number. kgja;kfjakl;fja doesn't really cut it.
Referrals from GP are an extra issue. And I have to be clear here - I have a huge amount of respect for GPs - without fancy equipment, blood tests and radiology, they have to work out how risky someone's condition is, just from the history and examination and make difficult decisions everyday with little information.
However, it can take several hours for non-life-threatening patient to arrive from a GP, and there are so many calls, it can be difficult to work out who has turned up and who hasn't. A&E will see a patient that was supposed to go straight to the medics, but because they don't know what is and is not accepted, they didn't know and it's wasted their time. There are some GPs that give the rest of the primary care community a bad name. They refer patients who should have been referred earlier or not at all.
Also for GPs, there has been a number of times when GPs have referred people and the accepting team deny any knowledge. Or a GP tries to circumvent the system by sending a letter with the patient addressed 'medical registrar' without having actually called them.
As a side issue, I find the rudest doctors who take referrals are either senior SHOs or junior registrars - there is no need for it. Rather say yes than argue for half an hour and then say yes.
Anyway, there is no mechanism I have seen thus far which accurately records for the originator and receiver of a referral.
Finally, one of the most difficult parts of an on-call is sending someone home. This may sound daft, but it is actually easier to admit someone into hospital then send them home.
So, for example, if someone is okay, or has been given treatment until they have an e.g. ultrasound in two days (and that is difficult enough to organise) and they need a review by someone after that ultrasound, it is a nightmare to organise. Normally, you have to find the 'tray' and put the notes in. Give the patient strict instructions (because there are going to be a whole new group of doctors and nurses in two days) - ask if anyone is around - hope they remember and tell everyone and hope it gets passed on. The patient will arrive in two days, get the ultrasound and then comes back for a review, and then will wait for a few hours as people run around trying to work out who they are and why they are there and why no one can find the notes (they were accidentally sent back to medical records off site and won't be delivered back for another two hours).
So, some sort of system to accurately pass on information of names, hospital numbers, DOB, clinical diagnosis and outcome for the new patients on call would be great. And I think this feeds in well to patients lists?
Nidhi
This is one for hospital doctors - the on call. The 'patient list' solution was great (congratulations) and it focused on the handing over of patients.
However, as a possible extension I want to talk about the problems of new patients.
So, a typical day on call. On call means the on-call team see all new patients coming into the hospital. This includes people who might not need admission walking into the Emergency Department who require (or as the case tends to be, not-required but are referred because it is easier to refer to medicine than send someone home) to the very sick patients who need immediate help.
Patients come in one of two ways: either referred directly to the medical team by a GP or referred from A&E.
Come in at around 08:30 and take the bleep (eugh) from the night registrar and find out if there are any patients still waiting to be seen. The patient list is started for the day - this tends to either be a piece of paper on the wall which people write on or is a computer excel sheet which is dedicated or a book which has stuff written in it - all in all, very unsatisfactory.
In hospitals the medical registrar or SHO takes calls from GPs and A&E/ED for patients they want to refer. The conversation goes something like this (with some typecasting for effect):
Referrer: Hi I am so-and-so and I have a patient with chest pain, possible minor heart attack and they need a troponin (specific blood test to rule out an heart attack) in six hours
Reg/SHO: Is the pain typical, what are their risk factors?
Bleep goes off - another person calling (most likely the person sitting next to the person currently on the phone)
Referrer: Um, they had sharp chest pain on breathing in, cough...
Reg/SHO writing down the number before the bleep goes off again
Reg/SHO: Okay, okay, what's their name?
Referrer: It is a 73 year old called lskfjszkjfhajfh;g, hospital number 123456
Reg/SHO: Is that algj;gj;jigisofgj? number 456789?
Referrer: Something like that
Bleep goes off again
Reg/SHO scribbles something down and makes a mental note to put it on the computer, if there is one
Reg/SHO puts phone down
Two hours later
Nurse: Did the medics accept a lkgja;gj;a? number 789123?
Different SHO: No, not on the list, there's a atusoitutiu number 345678, but not a slkgjakgjg
Different SHO bleeps the Reg/SHO and asks if they accepted sgkjklgjf;,
Reg/SHO: oh yes (checking scrawl), um, 73 year old chest pain, trop needed in a few hours.
Different SHO: Well this guy is 65 and has a raging pneumonia and can't breathe...
Reg/SHO: Bugger, on my way
Was there ever a 73 year old? Is it a mis-diagnosis? Is there another patient out there, waiting somewhere who will not be found for another three hours? Who knows - my bleeps gone off another three times during the course of the last five minutes and I am already 18 jobs behind for the day. No time to think.
When I do have a moment to think I go to A&E and ask about this mythical 73 year old - the person who saw them? Um, a bloke. Well the day shift has already has gone home and no one really knows anything without a proper name or hospital number. kgja;kfjakl;fja doesn't really cut it.
Referrals from GP are an extra issue. And I have to be clear here - I have a huge amount of respect for GPs - without fancy equipment, blood tests and radiology, they have to work out how risky someone's condition is, just from the history and examination and make difficult decisions everyday with little information.
However, it can take several hours for non-life-threatening patient to arrive from a GP, and there are so many calls, it can be difficult to work out who has turned up and who hasn't. A&E will see a patient that was supposed to go straight to the medics, but because they don't know what is and is not accepted, they didn't know and it's wasted their time. There are some GPs that give the rest of the primary care community a bad name. They refer patients who should have been referred earlier or not at all.
Also for GPs, there has been a number of times when GPs have referred people and the accepting team deny any knowledge. Or a GP tries to circumvent the system by sending a letter with the patient addressed 'medical registrar' without having actually called them.
As a side issue, I find the rudest doctors who take referrals are either senior SHOs or junior registrars - there is no need for it. Rather say yes than argue for half an hour and then say yes.
Anyway, there is no mechanism I have seen thus far which accurately records for the originator and receiver of a referral.
Finally, one of the most difficult parts of an on-call is sending someone home. This may sound daft, but it is actually easier to admit someone into hospital then send them home.
So, for example, if someone is okay, or has been given treatment until they have an e.g. ultrasound in two days (and that is difficult enough to organise) and they need a review by someone after that ultrasound, it is a nightmare to organise. Normally, you have to find the 'tray' and put the notes in. Give the patient strict instructions (because there are going to be a whole new group of doctors and nurses in two days) - ask if anyone is around - hope they remember and tell everyone and hope it gets passed on. The patient will arrive in two days, get the ultrasound and then comes back for a review, and then will wait for a few hours as people run around trying to work out who they are and why they are there and why no one can find the notes (they were accidentally sent back to medical records off site and won't be delivered back for another two hours).
So, some sort of system to accurately pass on information of names, hospital numbers, DOB, clinical diagnosis and outcome for the new patients on call would be great. And I think this feeds in well to patients lists?
Nidhi
Colin's Account
Jul 30, 2012, 3:09:03 AM7/30/12
to nhsha...@googlegroups.com, Adrian Mowat, Paul Wilson, Eckhard Schwarzat, Rob Dyke
Hi Nidhi,
We're still refining the app and could certainly look to include this.
We've already built in on-call lists that people can populate. Would be very easy to add an A&E referral to this. In fact you could do it already by naming a list when you're on-call 'patients to follow-up'. When you take the call you find them through your PAS, add to the list named whatever you like, then add the task that needs done.
If A&E wanted a generic list that can use for this that is accessible to all A&E staff we already have a function for that to be created.
Best wishes,
Colin
(Sent from my iPhone)
--
Dr Colin Brown
BSc, MSc, MBChB, MRCP
~ National NHS Fellow to the Health Protection Agency ~
~ NIHR Academic Clinical Fellow in Infectious Diseases & Microbiology ~
~ Alma Mata Global Health Graduates' Network, www.almamata.net ~
We're still refining the app and could certainly look to include this.
We've already built in on-call lists that people can populate. Would be very easy to add an A&E referral to this. In fact you could do it already by naming a list when you're on-call 'patients to follow-up'. When you take the call you find them through your PAS, add to the list named whatever you like, then add the task that needs done.
If A&E wanted a generic list that can use for this that is accessible to all A&E staff we already have a function for that to be created.
Best wishes,
Colin
(Sent from my iPhone)
--
Dr Colin Brown
BSc, MSc, MBChB, MRCP
~ National NHS Fellow to the Health Protection Agency ~
~ NIHR Academic Clinical Fellow in Infectious Diseases & Microbiology ~
~ Alma Mata Global Health Graduates' Network, www.almamata.net ~
Rob Dyke
Jul 30, 2012, 3:33:02 AM7/30/12
to nhsha...@googlegroups.com, Adrian Mowat, Paul Wilson, Eckhard Schwarzat
The Wardware app has a 'flag this patient' function which makes sticky at top of lists given ID from PAS.
/rob
/rob
From: "Colin's Account" <colinste...@gmail.com>
To: nhsha...@googlegroups.com
Cc: "Adrian Mowat" <adr...@newcontext.com>, "Paul Wilson" <pa...@newcontext.com>, "Eckhard Schwarzat" <e.sch...@valuedecision.com>, "Rob Dyke" <r...@tactix4.com>
Sent: Monday, 30 July, 2012 8:09:03 AM
Subject: Re: [nhshackday] On-Call - Extension to Patient Lists?
To: nhsha...@googlegroups.com
Cc: "Adrian Mowat" <adr...@newcontext.com>, "Paul Wilson" <pa...@newcontext.com>, "Eckhard Schwarzat" <e.sch...@valuedecision.com>, "Rob Dyke" <r...@tactix4.com>
Sent: Monday, 30 July, 2012 8:09:03 AM
Subject: Re: [nhshackday] On-Call - Extension to Patient Lists?
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Nidhi Gupta
Jul 30, 2012, 5:59:54 AM7/30/12
to nhsha...@googlegroups.com
If possible, the following features would be great:
- having the person who referred the patient
- having a suggested urgency like the urgency of the jobs...e.g see ptn immediately or within the hour etc.
- ability to transfer patient to e.g. day attender list
- time of referral, arrival, and being seen
- referrals to other specialties
Thanks
Nidhi
On 30 Jul 2012 08:39, "Rob Dyke" <r...@tactix4.com> wrote:
The Wardware app has a 'flag this patient' function which makes sticky at top of lists given ID from PAS.
/rob
From: "Colin's Account" <colinste...@gmail.com>
To: nhsha...@googlegroups.com
Cc: "Adrian Mowat" <adr...@newcontext.com>, "Paul Wilson" <pa...@newcontext.com>, "Eckhard Schwarzat" <e.sch...@valuedecision.com>, "Rob Dyke" <r...@tactix4.com>
Sent: Monday, 30 July, 2012 8:09:03 AM
Subject: Re: [nhshackday] On-Call - Extension to Patient Lists?
Hi Nidhi,
We're still refining the app and could certainly look to include this.
We've already b...
Colin Brown
Jul 30, 2012, 7:29:13 AM7/30/12
to nhsha...@googlegroups.com
Hi Nidhi,
- having the person who referred the patient (can be seen already)
- having a suggested urgency like the urgency of the jobs...e.g see ptn immediately or within the hour etc. (can colour code according to urgency)
- ability to transfer patient to e.g. day attender list (can be done already)
- time of referral, arrival, and being seen (will need to add)
- referrals to other specialities (can be done already through 'to do' function)
- having a suggested urgency like the urgency of the jobs...e.g see ptn immediately or within the hour etc. (can colour code according to urgency)
- ability to transfer patient to e.g. day attender list (can be done already)
- time of referral, arrival, and being seen (will need to add)
- referrals to other specialities (can be done already through 'to do' function)
Best wishes,
Colin
--
Dr Colin Brown
BSc, MSc, MBChB, MRCP
~
National NHS Fellow to the Health Protection Agency ~
~ NIHR Academic Clinical Fellow in Infectious Diseases & Microbiology ~
~ Alma Mata Global Health Graduates' Network, www.almamata.net ~
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