Renal Rundown

Team Structure

There are four arms to the Renal Department: Medicine, Transplant, Referrals and Dialysis (HOs cover Medicine). There are two HOs, usually a first year and then a second/third year. There are two amazing Clinical Nurse Specialists, Soloshini and Emma. They are GOLD. Emma is a vascular nurse specialist and Soloshini is a peritoneal dialysis nurse specialist, but they both look after everyone under renal medicine. Ask them about anything, they’re brilliant. The nurses are very competent and can help with protocols if you’re not sure, including location for venepuncture.

Pharmacist is your best friend - incredibly knowledgeable, which is great since pretty much all charting is different for renal patients! Ask them for the hospital password for the Renal Drug Handbook; it is a great resource when it comes to prescribing for patients with renal failure. Don’t do dialysis prescriptions without advice/directions from the CNS or registrar.

Daily routine

Rounds start at 0800. Aim to start at 7:50 latest especially on consultant WR days to prepare the list. You will need to consider the current ward patients, expected arrivals (including elective fistula and tunnelled line insertions). Consultants do a full round on Mondays and Fridays, and review just new patients Tues-Thurs. It’s useful to have one HO rounding, the other doing jobs for efficiency. On Tues and Thurs the registrar does a ward round, and on Weds the HOs do a ward round since most of the consultants and renal medicine registrar will be in clinic.

If you need urgent advice and have difficulty getting hold of a renal medicine consultant or registrar, contact consult or dialysis registrar for help.

1345 every day attend rapid round with Ancilla (Charge Nurse) on Ward 71.

Weekly events

General

This can be a busy run with sick patients; however it is a great run with consultants who are exceptionally supportive and approachable. It’s an excellent run for learning.

All dialysis patients with medical problems come under renal. Dialysis patients with surgical problems will go under the applicable surgical team, and the referrals team (which the house officers have nothing to do with) will manage the dialysis needs of these patients while they are IP. Most CKD5 and some symptomatic CKD4 patients with medical problems will come under renal. Also patients with active intrinsic renal diseases (e.g. glomerulonephritis and nephrotic syndrome) will come under renal regardless of whether they have renal impairment at time of admission/need dialysis acutely)

On Call

You cover med specs after hours and will have an offsider on weekday longdays who you will work closely with. Be collegial and use the “team inbox” on MedTasker to share the jobs, instead of only doing the jobs that are specifically MedTasked to you as this can happen quite unevenly.

Whoever holds the “Medspecs 1” phone will be the only one who receives calls so they will generally review the sick deteriorating patient (i.e. way more fun and better learning). On nights and weekends there is only one med specs HO). This run is well supported with a registrar for each service onsite/available over the phone until 10pm. Overnight there is one med specs registrar covering all of these subspecialties. On nights there is the 5/6am ABG round for overnight oximetry respiratory patients which you will need to do as the med specs HO. Do your best, if you can’t get them then let the CNA know; sometimes they will do it or leave it for the team in the morning.

You do not manage liver/renal transplant patients; this is a registrar level job only, no matter what the nurses request. Sometimes the appropriate registrar from these teams will delegate tasks to you e.g. charting, fluid review. Do not decline these requests

Clinic

Located at the first floor of the Greenlane Clinical centre.

You will be allocated 2-3 registrar clinics for the run (when they are on nights/leave) to assess and manage new patients not previously seen by renal (maximum of 3 patients). You will receive an email from Prue to let you know which clinics you will be doing. Discuss your patients with the consultants. You have one hour per patient including time to dictate.