On-call Guidance for Resident Doctors

The following materials are a reminder of what an appropriate handover should include and to give some examples of what an appropriate job is to be handed over on-call and what is not. This list is obviously not exhaustive but is designed to give a flavour of how things should be directed.

Please refer to these is required when you are both giving a handover and receiving one, to allow you to adequately triage whether this is a job you should accept / be handing over to your colleagues

You should also have access to the handover system - this can be found in the NottsHC Shortcuts - Handover.

Please ensure that you do before you on-call shift, and if you do not have access please contact - medicalworkforceenquires@nottshc.nhs.uk 

Medical on-call cover is onsite at Highbury, Hopewood, Sherwood Oaks and Blossomwood. It remains an acute service for medical cover outside of normal working hours and for urgent medical cover in hours when ward medics are not available nor contactable. In hours, please always try to contact the regular ward medics first and then appropriate cross covering wards before contacting the duty doctor unless it is an emergency. All calls to the duty doctor should be presented using the SBAR format.

Who should I be contacting?

Immediate / urgent medical review of stable patient

Appropriate escalation of reviews that need completing as soon as possible. Always use SBAR handover. Examples include (but are not limited to):

Urgent physical health concerns

• Chest pain
• Shortness of breath
• Hypo/Hyperglycaemia (outside care plan)
• Severe self-harm / overdose
• Foreign body ingestion
• Mental health medication side effects
• Seizures
• Falls 
• Infections
• Post ligature review for cyanosis, low oxygen sats or neck injury 
• Urgent bloods unable to be taken by duty ECG/phlebotomy staff

Urgent mental health concerns

• New admission clerking
• Assessment for Section 5(2)
• Requesting self-discharge 
• Seclusion reviews 

Urgent prescriptions 

• Benzodiazepines or rapid tranquilisation
• Acute alcohol withdrawal 
• Analgesia (not paracetamol - PGD available)
• Antibiotics 
• New prescriptions following return from acute general hospital

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Unstable patient / medical emergency

• Follow MEDICAL EMERGENCY PROTOCOL
• Call ambulance if appropriate 
• Call duty doctor immediately with SBAR handover 

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SBAR

Situation

• Identify yourself 
• Identify the patient 
• State why you are calling

Background

• Patient admission details and mental/physical health diagnoses
• Recent significant events
• Recent physical observations/NEWS2
• Current medication

Assessment 

• What are your findings following discussion/assessment
• Why are you concerned?

Recommendation

• What do you need from the doctor?
• Ask if there is anything can do in the meantime 

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Non-urgent medical review of stable patient

Jobs identified but are not urgent, not appropriate for night escalation and can wait until daytime/return of regular ward team. 

• Non-urgent prescriptions 
• Routine physical health concerns (something appropriate for routine GP appointment in the community)
• Chasing non-urgent investigations

Nursing team to document plan to discuss with day medical team in hours and handover job as appropriate. 

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Before calling the duty doctor, have you...

• Contacted ward/covering ward doctors first?
• Checked if there's a care plan in place already?
• Checked Rio documentation - has this been discussed before?
• Checked what medication is already prescribed?
• Asked yourself if this is the most appropriate time to escalate this concern (would I go to the GP about this, if so can it wait for the day/in hours team)?