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General Surgery Rundown

General Information

You are entitled to a free breakfast if you arrive before your rostered hours.

Gen Surgery hours can be long, but you are generally well supported.

Help each other out when snowed under. Consider making a group chat for the Gen Surgery HOs (a place where you can offer help when you’re not busy, find out who’s on call to hand over to on evenings, etc).

Wards

76, 78, 81. Vascular (ward 41) have their own HOs but you will cover this ward afterhours

General tips

The earlier in the day you discuss scans, the higher the chance they’ll be done that day.

The Gastroenterology team consents patients for ERCP.

Common post-op complications to be aware of: urinary retention, hypotension and tachycardia, sepsis, fever, LRTI, arrhythmias, wound infection/dehiscence, ileus/obstruction, DVT/PE, ETOH withdrawal.

Long day shifts

You will be rostered as either the ward HO (covering 41, 76, 78, 81 and any outliers) or acutes HO (working in ED/CDU).

The ward HO carries the MedTasker phone (pick up from level 5 reception at 1600).

The acutes HO helps out the admitting registrar. It is cushier than the wards so if possible, offer the ward HO some help with their jobs.

The handover for long day is at 1630 in the meeting room between wards 76/78. The handover for the night HO is at 2200 and is in CDU.

Acutes

Write notes for the registrar. Chart regular medications, 3x analgesia (most registrars like paracetamol, tramadol and IV morphine) 2x antiemetics (usually ondansetron and cyclizine) and ask registrar if they want to start antibiotics (Usually “Cef and met” – IV cefuroxime and IV metronidazole) and DVT prophylaxis (usually clexane).

Put up next-day bloods if required.

If the patient is for theatre: fill out a purple acute booking form, fax to x24877 and phone theatre coordinator and anaesthetic coordinator to ensure received and discuss OT requirement.

There is also the option to use the online SCOPE form for theatre booking (you will still need to call the theatre and anaesthetic coordinator). Remember to also fax a COVID form to theatre (25877).

Document NBM status (usually from 0200) + maintenance IVF. Ensure you hand this over to their nurse.

On Call Weekends

There are three HOs on call: two for long-day (ward and acutes/admitting) and one post-acute HO till 1600. It is helpful to put together a weekend WhatsApp group. Usually meet at 0715–0730 on ward 78/81 to print the list of ASU patients and put out blood forms.

0800 handover in meeting room between wards 76/78 prior to ward round. Night house officer passes the ibleep phone to ward HO or post acute HO.

At the morning handover the seniors will decide amongst themselves which patients they will round on.

The subspec teams see their own patients but may call you for some jobs if needing an extra hand. It is flexible which HO follows who on the round, although it usually works best for the admitting HO to focus on downstairs patients primarily. After the ward round the ASU registrar and all three HOs do a paper round and divide jobs.

On Saturdays there is a dedicated vascular house officer from 0800-1600. Outside of these hours the weekend ward house officer also covers Vascular. This may include doing pre-op admissions on Sundays.

Bloods

For post‐op bloods, check with your registrar to see what's needed for your team. Typically, you'll need to do FBC, U&Es, Creatinine and CRP (which will be elevated right after surgery). For HPB patients, also include LFTs

Subspec House Officers put up weekend bloods for their own team’s patients (Sat, Sun, Mon).

Weekend House Officers put up ASU bloods on Sat, Sun.

ASU HOs return on Monday morning to put up mane bloods.

You are responsible for handing over your team’s bloods to the weekend ward house officers to chase (unless you are ASU) along with any relevant clinical information and specific plan for abnormal results.

WOCHO/Post acute HO chase ASU patients’ bloods. Any concerns to be d/w on call registrar. All patients for surgery need full blood count, G+H and coag screen.

Key points

  • To do well in general surgery, stay organised, manage your time well, and keep communication open with your team.

  • Take care of yourself by eating right, getting enough sleep, and finding healthy ways to manage stress.

  • After tough cases, make sure to debrief with your team to reflect and learn.

  • Stay calm during trauma calls and don’t forget to reach out to mentors and peers for support and advice.

  • Also – enjoy the run! Don’t forget to enjoy your work, bond with your team, and seize opportunities to teach students and go to theatre.