A typical shift in A&E department

A&E DEPARTMENT:

Is divided into 3 sections mainly. 1)Majors 2) Minors 3)Resus

We are asked to work anywhere by a consultant.

Typical Shifts in My Trust:

All of 8 hours except night shifts which are of 11 hours.

Examples: 8am-4pm, 11am-7pm, 1pm-9pm, 3pm-11pm, 5pm-1am, 6pm-2am, and 9pm-8am.

How does a typical day start?

Handover only occur for 8 o’clock shift. Night team actually hand over patients to you some of which are already admitted or deemed Medically Fit For Discharge (MFFD).

In all other shifts, you do not have to take handover. You just have to go to the reception, pick the patient in the order of their time of booking/arrival. Some consultants want to give you patients themselves whilst others expect you to pick patients according to their booking time.

What to do when you have picked a patient:

Either your patient will be in the cubicle already or in the waiting room. If in the cubicle, you just go and see the patient. If not, call the patient into one of the vacant cubicles, and see the patient.

It is always better to see the quick patient’s history on computer (ambulance sheet information and any of recent consultation letters showing patients past medical history and meds) before starting your consultation. It gives an idea of the background of the patient’s visit beforehand.

Then you have to discuss the case with the consultant who will listen to your presentation and will have these two questions. Ok what do you think is wrong with the patient (likely diagnosis, differentials) and what are you going to do?

You are expected to stabilize the patient first before discussing with the consultant for example you must have given painkillers to the patient before asking for advice etc. In addition, it is important to tell the jobs to the nurses like ECG, MSU, giving medications etc.

Investigations:

If the nurses are free and cooperative, they will do bloods. Otherwise, you have to do bloods, cannulations for your patient. Most of the time they do VBG (venous blood gas), take bloods, and leave them in the file for you to send, as you might want to add other bloods and sign the blood forms.

We have to request X-ray requests for patients and print the form and put it in the right slot. Porters will come and pick that up. CT or MRI requests, however, need a discussion with Radiologist sitting next to department. If they approve it, they will take the request form and will call for the patient.

Sometimes, you might be asked to do urine dip by the nurses. It rarely happens.

End of Shift:

Always handover your patients to your colleagues before leaving even if there is nothing for them to do. If there are some pending jobs, handover those too. It is uncommon to handover to handover patients without clear plans like if you handover to chase bloods, you should tell then what to do if normal results come and what to do if xyz is raised.