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Orthopaedics Rundown

Team structure and wards

The orthopaedic wards are 75, 77, and 81.

There are five teams, each are on call one day a week i.e. the ‘Monday’ team is on call from 1800 Sun to 1800 Mon.

Patients generally stay under the consultant who operated on them i.e. a patient admitted on Monday but was operated on a Wednesday becomes a Wednesday team patient (this often doesn’t apply if it is the patients second time to theatre).

On your team’s on call day, handover is at 0730 in the meeting room between ward 77/78.

Daily routine

Ward round start time is team dependent (0630-0730). Rounds are FAST. Carry a clipboard with pre-printed WR note template, a supply of consent forms, and cast scripts. Only registrars can sign cast scripts so ensure you get them signed on the round. During the round, clarify weight bearing status, DVT prophylaxis and follow up plans including clinic follow up (registrar v. consultant? X-ray on arrival (XROA)?)

After rounding, file notes in folders and check obs/notes/other service reviews/med charts. Rapid round occurs at 0930 on the ward.

Scope

Unique system to ortho for patient list management, theatre booking, etc. Each team divides the responsibility for keeping this up to date differently. Clarify with your team. Printing lists: strongly recommend that you get a tutorial from outgoing house officers or CNS (get them to show you how to set up your settings).

Weekends

On Fridays:

  • Weekend plans should be put up on ward 77 for all patients who need reviews or investigations chased over the weekend.

  • You should verbally handover to the weekend house officer anyone who is sick and needs review early in the day.

  • Phlebotomy rounds are time-limited, so only put up absolutely necessary bloods for the weekend.

Weekend rounds:

  • Start between 0700–0730 (consultant dependent – check with junior reg) meeting room between ward 77/78. Reg will print lists.

  • Get Ortho/Uro phone from NOCHO - usually meet them on ward 75 or 77

  • There is a separate Weekend WR template. Make sure you have a supply of these printed with the correct SMO name prior to rounding.

  • Do the ward round then jobs from the round and weekend jobs (on ward 77), and answer MedTasks. Registrars from all teams may hand jobs over to you.

  • 0800-2200 on the weekends you only cover Orthopaedic MedTasks (there is a separate Urology house officer on till 2200). On nights you also cover Urology.

OPH rounds

Each team will have an OPH registrar assigned who will round on Ortho patients over 65 years old. Check with the OPH registrar in the first week to arrange rounds. The OPH registrar is your lifeline to medical services for patients over 65 (or sometimes younger if Māori/Pacific Island patients). Notify them early if you have patients with OPH needs.

Prepping acute admission for OT

Pre-op bloods including coags and G+H most of the time (all joints). Chart fluids (if NBM) and regular meds (these will usually not be done at the time of admission).

Pre-admit clinic

There is a MOSS (Dr. Rajeeva Gooneratne) who runs this clinic daily. One HO from each team attends one day per week. You will see a list of patients and ensure they are ready for OT. They usually won’t have an OT date yet. They are seen by a nurse and by anaesthetics on the same day.

Rajeeva will give you a tutorial on what is required at the start of the run. The most pertinent things (that could get you into trouble) are pre-op bloods, ordering hard-copies of films and which medications should be withheld.

General tips

Clinic is automatically booked by the ward clerk if written in discharge summary for ward 75/77/81 patients but for outliers, give a sticker to Christina (Ward Clerk on 77) and she can book for you.

Some teams are far busier than others, and this varies day-to-day and week-to-week… help out your team mates.

Your CNS will be your best friend, be good to them.

Radiology requests need to be discussed with MSK radiologist. Go in person, they won't talk over the phone. MSK USS needs to be discussed unlike other USS. Steroid injections are requested on ROERS through interventional but then needs to be discussed with MSK.

If a wound starts bleeding, elevate and apply pressure with a pressure dressing and monitor. Try not to change dressings as increases risk of infection. If dressing soaked however, should change as this also increases risk of infection. If not settling, call your registrar.

Have a high index of suspicion for compartment syndrome.

If you need help, ask for it. Remember you can call the PAR team, call the medical registrar or orthopaedic registrar, or call a code if you need to.

Always check the reason patients are on antiplatelet/anticoagulation prior to admission (AF, primary or secondary prevention, previous PE/DVT) as this influences decision making around length of cessation or co-prescribing of blood thinners.

Making the most of the run

Not all of you who end up on an ortho run are going to be interested in pursuing orthopaedics. The Regs, bosses and CNMs all understand this. If you intend on pursuing a career in ED, General Practice, General Surgery, Urgent Care, Radiology or one of the other medical specialities however, this can be one of the most useful runs you end up doing, as orthopaedic problems are part of your bread and butter presentations within these specialities.

The Friday morning’s X-Ray meeting (0700 - 0800 on level 5 Radiology Suite) will likely be some of the best regular radiology teaching you will receive. Grab an early coffee and attend; especially if this will be the only Orthopaedics run you intend on doing.

Go to theatre when you can. For the keen orthopods this won’t be a chore; but again for others intent on other specialities this is an awesome opportunity for learning.

Practice suturing, get an understanding of common surgeries so you can explain them to your future patients and gain an appreciation for the why and how different issues are managed. Just make sure someone is holding your pager. The bosses love having you there. Try and assist the Regs on admitting in ED when able. Helpful for learning clinical examination, reviewing images and initial decision making.