Cardiology Rundown

Wards

As of April 2021, there are six cardiology house officers in the run:

• Two on the wards (ward 31)

• Two on CCU (ward 34)

• One in CDU

• One floating house officer – covering the other house officers during RDOs

Daily routine

There is often teaching or various meetings which occur in the morning, so ward round may start at a variable time depending on your team/SMO:

• Monday: 8am

• Tuesday: Registrar teaching from 7.30‐8.30am. This means ward round is likely to start at 8.30am depending on the SMO

• Wednesday: Cardio surgical conference 8‐9am. The CSC is a joint meeting between the cardiologists and cardiothoracic surgeons to discuss patients for surgical consideration. It is most useful to go to these if you have patients who need to be discussed, however, equally a good opportunity to see how cases are presented and discussed. Ward round will start at 9am / after your patients are discussed or at 8am if your team has nobody to discuss (depends on team preference) ‐ House officer teaching occurs around 3.30‐4pm on Wednesday

• Thursday: Cardiology departmental teaching 8‐9am. These are often presented by the registrars and good learning – whole department including SMOs attend.

• Friday: Most often will start 8am. There is a cardiac transplant meeting so SMOs involved in transplant may not start until later, but often the Reg will start rounding

• The weekly schedule gets emailed on Friday the week prior

Usually, the SMO rounds every day. Monday is generally a full SMO ward round, and thereafter they may decide to see new or complex patients only throughout the week.

The system for CCU and the ward is there are two teams which alternate with being ‘on take’ for 24hrs from 8am to 8am the following day:

For CCU 1/ward 1: On take for Monday, Wednesday

CCU2/ward 2: On take Tuesday and Thursday

Friday + weekend take will alternate between the two teams

This generally means that one team will be busy whilst the other team will be quieter. Help out your colleagues!

When your team is ‘on take’: HO job involves clerking patients who arrive to the ward/CCU. This involves taking a brief history and charting medications. Often it will be patients who arrive for surgery, as they remain under cardiology until they get their surgery then get transferred under CTSU. This can be a written admission note or use the cardiology inpatient consult note on eclair and head it with HO admission note. Be mindful of which medications should be withheld prior to surgery (e.g. ARB/ACE, anticoagulation) – there is a chart re: anticoagulation on the wall behind the computers in Wd31.

Blood forms need to be put up for Wd31 (most need daily U+Es on IV Furosemide but check with Rag). On CCU the nurses overlook the bloods so forms do not need to be put up.

Interventional patients: Patients under the EP team or TAVI team are often a day case on Wd38 and then usually stepped down to ward 31. The ward house officer whose team they are admitted under will have to discharge these patients. Often the discharge is prepped by the nurse specialists, and they are a good first line for discharge related queries. The TAVI SMOs will often see the patient and write a note in the morning to clear the patient for discharge. These patients will also have a TAVI or interventional booklet in the folder for guidance.

CDU:

• The CDU HO job involves scribing +/‐ charting regular meds for the admitting registrar. There is a laptop in the cardiology offices which can be used for this.

• The admitting registrar will change after 12pm. You often need to find out who the CDU Reg is and they are usually the same person in the morning for the week at least. The afternoon Rag after 12pm alternates.

• Great opportunity for learning how to admit patients and to ask questions

• Variably busy but usually busier in the afternoon. If the morning is quiet, the CDU house officer often helps the busiest team on CCU/ward31 with jobs.

• If there is a HO vacancy despite the float HO, the CDU house officer may need to cover that internally as directed by the chief registrar. Float HO:

• Covers any HO on RDOs – CCU/CDU/Wards. HO leave is usually covered by RMO unit.

Discharge summaries

See draft templates in L:\Groups\EVERYONE\Cardiology draft EDS

On call

• There are two CCU teams and two ward teams on call: -Team 1 is on call Mon + Wednesday + Fri/Sat/Sun -Team 2 is on call Tues + Thursday + Fri/Sat/Sun (alternating)

• When on call (1600‐2200) you cover Ward 31 and CCU. Log into Medtasker on the on‐call phone for these shifts. You will still get called as well. The on call phone lives in Ward 31.

• Weekends: 2 HOs and two registrars (one on ward 31 and one in CCU). Each person will be rostered on for one short day (until 4pm) and one long day (until 10pm) on the weekend. You will round with the team on all patients in either CCU or the ward.

• With the addition of extra house officers, the workload is generally very light both during the day and after hours (sometimes too light…).

• Whoever was on CCU/Ward 31 during the week usually remains on their ward if they are allocated for the weekend.

• On Sunday afternoons elective CTSU patients arrive and need to be admitted. As these patients are admitted under Cardiology pre-operatively, it is technically your responsibility to clerk them in.

• Nights: no nights for Cardio HOs! CTSU HOs cover nights for Cardio.

Other tips

• Common cardio drugs needing special authority: Ticagrelor, Entresto and Empagliflozin (often self‐funded).

• Take Echo and Angiogram request forms with you on the CCU round and do them as you go.

• House officers should have access to the angiogram forms on Éclair but sometimes have to contact IT if not. Echo is requested through eRef (with perks of getting done quite fast!)

• Procedures take place on level 3 in the cardiac investigation unit if interested; you will find you have time on your hands during your weeks on CDU and as the floating HO

• ACH Cardiology will receive a lot of transfers from NSH/MMH for patients requiring cardiothoracic surgery. The ward or CCU HO is often required to “admit” these patients which can be tedious. Save yourself time for this admission by printing out:

  • The cardiosurgical summary (usually present for all patients awaiting cardiac surgery)

  • The discharge summary from where they were transferred

  • Attach these to your admission note – add in the exam findings (+ chart reg meds)