Working as part of a team
Standards of behaviour
In a busy hospital environment, with the inevitable stresses of acute care, compounded by tiredness, uncertainty and anxiety, there is the potential for communication difficulties or conflict between team members and patients. We have, however, a zero tolerance for unprofessional, disruptive behaviour by RMOs. Communication with nurses, colleagues and patients must always be civil and professional. If there are difficulties communicating with others in the hospital, discuss this with your Registrar or SMO.
Time management
It is important that you are punctual for ward rounds, team meetings, ‘rapid rounds’ etc. If you are going to be late for a ward round, clinic, handover or other meeting, call your Registrar or Consultant. Try to finish all of your work before leaving. If you can’t, and it needs to be done, make sure you hand over to the responsible RMO.
Ward rounds
Record all management plans.
Communicate any changes to nurses looking after the patient.
Carefully follow-up previous decisions / documentation.
Patient discharges
Discharge planning should start at the time of admission. Try to predict the discharge date – this is good for ward planning and for the relatives. Complete the electronic discharge summary for each patient. At the start of the run, check if there are any rules regarding discharge from the service.
Handover
Handover to the next RMO is an essential part of good patient care. It is also good to complete any tasks that need to be done to facilitate discharge or transfer of patients after-hours or weekends.
Complete weekend plans for every patient.
Prepare discharge summaries for patients who are to be discharged at the weekend.
Hand over jobs to be done / unseen patients / medical contacts / complex patients / patients you are worried about to the next RMO.
Daily handover to on-call team for patients requiring attention during the evening.
Friday afternoon handover to weekend teams for patients requiring attention over the weekend.
Try to finish all your work before leaving.
Request bloods / other investigations if they need to be done over the weekend.
Sign off unaccepted lab results.
RMOs’ relationship with on-call SMOs
When you are on call, discuss with your Registrar or SMO the threshold for calling (this differs between specialties and services).
Don’t create any surprises for the SMO – call if a patient unexpectedly deteriorates or dies.
The ultimate responsibility for patient care lies with the SMO – keep your SMO informed if there are ongoing problems.
Request for specialist opinion
Remember that a consultation with another service is a specialist-to-specialist discussion which you are facilitating. If you are the first contact with a referred patient, you must discuss the problem with the SMO. Record the SMO’s name in the notes.
If you write the consult note, include any comments by the SMO and indicate that he or she has seen the patient, or discussed the case. Ask a specific question.
You may need to contact the referrer to determine the urgency of the problem. This is not always apparent from the referral letter.
RMOs accepting GP calls
If you take calls from GPs on behalf of your in-patient service, and the patient needs to be admitted or assessed, you must accept the patient rather than expect the GP to try and find a more appropriate person.
Transfer to a more appropriate service can occur after review by negotiation with fellow RMOs.
Sickness
If you are unable to come to work during the week, contact the RMO Support Unit and your Registrar or SMO. On weekends, call the Duty Manager and your Registrar or SMO. As much notice as possible should be given.
Dress
Your clothes must be professionally appropriate.
Teaching
Teaching is part of the job and can be very rewarding. You will be expected to teach and role-model for medical students and other staff. Students often learn a lot from the House Officer.
If you do not know what to do, ASK. Your colleagues, seniors, nurses, ward clerks, etc. are there to help.