This section of the website provides information and resources relating to all aspects of Medical On-Calls at Birmingham Heartlands Hospital. Please navigate through the content using the buttons at the bottom-left of the page.Further details are provided in the Medicine On-Call Policy for Birmingham Heartlands.
On-calls for Acute / General Medicine are often some of the busiest shifts on a junior doctor’s rotation; there is an average medical ‘take’ of 60-70 referrals per day at the Birmingham Heartlands site. Despite this intensity, on-calls can be a very rewarding and enjoyable clinical experience, with exposure to a wide range of acutely unwell medical patients, high levels of Consultant supervision (during the day and evenings) and ample opportunity for training, education and the completion of workplace-based assessments (including ACATs).
The hub for general/acute medical on-calls at Birmingham Heartlands Hospital (BHH) is our Acute Medical Unit (AMU) on Ward 20. AMU is divided into 4 zones with 34 medical assessment beds (Zones 1, 2 and 4) and a 10-bedded chest pain assessment unit (CPAU in Zone 3). There is a central on-call doctor’s office on AMU (located between Zones 1 and 4) which houses a large television screen displaying the list of patients to be clerked on AMU (in order of arrival), using a programme called MSS: Patient First (the same programme that is used to track patients in ED). The Seminar Room on AMU is the venue for every medical handover.
Monday-Friday from 08:00-21:30 there is an Acute Medicine Consultant supervising the take who is responsible for reviewing all new admissions and providing support to the junior medical team. Outside of these hours, the take is the responsibility of the General Internal Medicine (GiM) Consultant On-Call. During weekdays, the on-call team is assisted by trainee doctors, Trust Grade doctors and Advanced Clinical Practitioners (ACPs) working in Acute Medicine.
A 90-minute induction session to Medicine On-Call at Birmingham Heartlands (covering a lot of the information on these pages) will be provided to ALL new-starter F1, F2, CMT and ST3+ doctors due to participate in the General / Acute Medical on-call rota at BHH. This will occur as part of their formal Trust induction in the Education Centre at BHH on the first Wednesday in August (last Wednesday in July for F1s), prior to trainees being released to the wards for their departmental / local inductions.
The on-call induction session will be repeated in the Education Centre at the 4-month changeovers on the first Wednesday’s in April and December. For doctors rotating to specialties on the medical on-call rota at BHH outside of these times, smaller induction sessions may be arranged in the AMU seminar room on the first Wednesday of each month when required.
Induction to on-calls will be delivered by a group of consultants working in Acute and General Medicine at BHH and will cover the following:
- ► Deteriorating Patients including MEWS escalation policy and sepsis pathway
- ► Introduction to Medical On-Calls including the AMU, on-call roles and responsibilities, handover and housekeeping rules
- ► Medical Rotas including shifts, swapping shifts and sickness absence policy
- ► IT systems for Medical On-Calls covering MSS, Concerto, iCare, PACS and Electronic Prescribing (EP)
- ► Training and Learning On-Call
A copy of the on-call induction presentation can be downloaded here.
Your On-Call rota for Medicine at Birmingham Heartlands should have been emailed out by our Medical Workforce Lead for Medicine at BHH, at least 6 weeks prior to commencing your post. If you did not receive a copy of this rota, please email Neil Griffiths (Medical Workforce Lead). Weekend On-Call rotas for Medicine at BHH are emailed out to all consultants, managers and site matrons on-call for that particular weekend on the Friday just prior to the weekend.
The latest on-call rotas for Medicine at BHH are also available on the intranet Medical Rotas page.
The procedure for swapping on-call shifts will be briefly explained to you during the Medicine On-Call Induction sessions that occur every 4 months upon rotation to posts participating in the Medicine On-Call rota.
Further details regarding swapping on-call shifts can be found in the relevant section of the Medicine On-Call Policy
You will need to download and complete a Swap Form for every shift that you swap. This form needs to be signed by the person agreeing to swap the shift and then countersigned by the persons responsible for co-ordinating their departmental rota and your departmental rota. The fully completed form should be returned to Neil Griffiths, Medical Workforce Lead for Medicine, 1st Floor Education Centre, Heartlands Hospital.
There are a variety of ‘on-call’ shifts at every medical grade during the week and at weekends / bank holidays. These shifts provide cover for the acute / general medical take, AMU and medical wards (out-of-hours). During weekdays (Monday-Friday), the on-call medical team receives additional support between 08:00-21:30 from Consultants, Trainee / Trust-Grade doctors and Advanced Clinical Practitioners (ACPs) working in Acute Medicine at BHH.
The various on-call shift times are summarized below according to grade and day of the week. A concise summary of on-call shifts and responsibilities for F1, F2, CT1 and CT2 doctors can be downloaded here. A more detailed description of the working patterns, roles and responsibilities for every shift is provided in the Medicine On-Call Policy.
F1 On-Call Shifts
Monday-Sunday (including bank holidays)
- ► F1 Day 09:00-21:30
- ► F1 Night 21:00-09:30
SHO (F2 / CT1 / CT2) On-Call Shifts
- ► SHO Twilight 14:00-00:00
- ► SHO Night 21:00-09:30
Friday-Sunday (and bank holidays)
- ► SHO Day 09:00-21:30
- ► SHO Night 21:00-09:30
Registrar (ST3+) On-Call Shifts
- ► RMO1 Day 09:00-21:30
- ► RMO1 and RMO3 Night 21:00-09:30
- ► RMO2 17:00-21:30
Saturday-Sunday (and bank holidays)
- ► RMO1 and RMO3 Day 09:00-21:30
- ► RMO1 and RMO3 Night 21:00-09:30
- ► RMO2 09:00-17:00
Consultant On-Call Shifts
- ► Acute Medicine Consultant On-Call 08:00-21:30
- ► GiM Consultant On-Call (Non-Resident) 19:00-08:00
Saturday-Sunday (and bank holidays)
- ► GiM Consultant On-Call Day 08:00-19:00
- ► Acute Medicine Consultant 08:00-14:00
- ► GiM Consultant On-Call Night (Non-Resident) 19:00-08:00
Handover, particularly of temporary ‘on-call’ responsibility, has been identified as a point at which errors are likely to occur. Failure in handover is a major preventable cause of patient harm, and is principally due to the human factors of poor communication and systemic error. These can lead to inefficiencies, repetitions, delayed decisions, repeated investigations, incorrect diagnoses, incorrect treatment, and poor communication with the patient.- RCP Acute Care Toolkit 1: Handover, 2011
All handovers for the medical on-call at BHH take place in the seminar room on AMU (Ward 20). Monday-Thursday there are 5 medical handover / sign-in times (09:00, 14:00, 17:00, 21:00 and 00:00). Friday-Sunday and on bank holidays, there are only 2 medical handovers per day (09:00 and 21:00). Each handover time has a distinct purpose, format and attendance; these are summarized in the handover checklists, available from the handover page of this website; full details are provided in the Medicine On-Call Policy for BHH. Laminated copies of the handover checklists for each handover are fixed to the table in the AMU Seminar Room on Ward 20.
An electronic handover register MUST be submitted for every handover. These are also accessible via the handover page of this site. The handover registers are password protected; the password can be found on the laminated handover checklists in the AMU Seminar Room.
Verbal communication at every handover of care (telephone or face-to-face) should follow the standardized SBAR format.
Handover of critical tasks / patients should always be documented fully in the medical notes, including the clinical information provided and the name / grade of the clinician receiving handover who is responsible for on-going care of the patient. Patients requiring medical review or tasks to be completed out-of-hours (over the weekend or after 17:00 during the week) should always be added to the appropriate patient worklist (i.e. Middle, Tower or Elderly) on the online Concerto system by the clinician giving handover, even if a verbal handover has already been given.
The Medical Emergency / Cardiac Arrest Team at BHH comprises a Team Leader; a person competent at airway management; persons competent at defibrillation and IV cannulation; persons to prepare drugs / perform chest compression and a runner. The Resuscitation Service at BHH does not currently have capacity to provide a member of staff on the Medical Emergency / Cardiac Arrest Team at BHH.
Medical Emergency / Cardiac Arrest Team roles and bleeps for the Medical SHOs and CCOT Nurse Practitioner should be specifically assigned at medical handovers and documented on the relevant online Handover Register.
Medical SHO1 (CT1/CT2)
Medical SHO1 (F22/CT1/CT2)
CCOT Nurse Practitioner
ITU Registrar / SHO
Drugs and IV Access
1 Either of these roles may alternatively be assumed by a suitably competent and ALS-certified Acute Medicine Advanced Clinical Practitioner (ACP) or Trust Grade Doctor in Acute Medicine.
2 F2 doctors should NOT assume the role of Team Leader; they may still carry the 2371 bleep provided that the 2370 bleep is held by a more senior clinician who acts as Team Leader.
The RMO1 is not usually expected to carry a crash bleep unless there are no doctors of CT1 / CT2 grade or other suitably experienced clinicians available at handover to assume the role of Team Leader. However, the RMO1 is expected to be available at all times to urgently attend any medical emergency / cardiac arrest (by fast-bleeping 1085) when requested by other members of the crash team.
It is expected that all members of the team will maintain their skills in the management of emergency and critical care scenarios through repeated practice and training. The Team Leader must be Resuscitation Council (UK) ALS qualified and have the experience / competencies to lead a medical emergency or cardiac arrest scenario; the team leader has the following responsibilities at a cardiac arrest:
- ► identifies themselves as team leader at the earliest opportunity
- ► makes decisions safely, quickly and confidently
- ► gives clear and precise instructions, allowing experts to work autonomously
- ► completes accurate documentation of medical management of the emergency, including completion of the cardiac arrest documentation proforma
- ► ensures effective and appropriate communication with the relatives
Further details regarding the Cardiac Arrest Team at Birmingham Heartlands are provided in the relevant section of the Medicine On-Call Policy for BHH
All the 'non-medical' ward areas at BHH are linked to a General Internal Medicine (GiM) specialty team which is designated as their ‘buddy ward'. Details of the buddy ward system and the linked wards are provided in the Medical Buddy Ward Policy. The care of all medical (GiM) patients outlying on these wards is the responsibility of the designated medical team (irrespective of source of admission) until either:
- ► the patient is transferred to a more appropriate (medical) ward by liaising with the bed management team on ext. 40483 or;
- ► care of the patient is formally accepted by another team because they need on-going specialist care (handover of care and the named consultant accepting responsibility for the patient should be documented in the medical notes) or;
- ► the patient is discharged from hospital
If a non-medical ward / specialty requires a general / acute medical opinion on one of their own specialty patients, they should contact:
- ► 09:00-17:00 Monday-Friday their designated buddy ward / medical team in the first instance
- ► 17:00-21:00 Monday-Friday RMO2 on bleep 1086
- ► 21:00-09:00 Monday-Sunday RMO1 on bleep 1085
If a non-medical ward / specialty requires a specialist medical opinion (e.g. haematology, renal, respiratory, gastroenterology, ID, oncology), in the first instance they should contact the appropriate specialty on-call SpR / Consultant directly rather than going through the buddy ward team or RMO1 / RMO2. A daily on-call rota with contact details for all specialties at BHH is available here.
The procedure for Sickness Absence will be briefly explained to you during the Medicine On-Call Induction sessions that occur every 4 months upon rotation to posts participating in the Medicine On-Call rota.
When unable to attend work due to unexpected illness, you are personally responsible for contacting the Medical Workforce Team and your line manager (for on-call shifts this is the consultant on-call or out-of-hours the RMO1) by telephone to inform them of your sickness absence and the reasons for it. This should occur as soon as practical, and in all instances, at least 4 hours before your shift is due to start (i.e. before 17:00 if you are due to start a night shift at 21:00), in line with local reporting procedures. Only in exceptional circumstances (e.g. when hospitalized as an emergency), can an employee nominate someone else to make contact with Medical Workforce and their line manager.
Between 08:00-17:00 Monday-Friday and 09:00-1600 on a weekend / bank holiday, contact the Medical Workforce Team on 0121 424 0217 (ext. 40217). You should then telephone the hospital switchboard on 0121 424 2000 and ask to speak to either the Consultant On-Call for Medicine or the RMO1; do not rely on Medical Workforce to inform these individuals regarding your sickness absence.
Outside of these hours you need to telephone the hospital switchboard on 0121 424 2000 and inform either the RMO1 or Consultant on-call for Medicine and the On-Call Site Manager / Nurse Practitioner regarding your sickness absence.You should then telephone 0121 424 0217 (ext. 40217) and leave detailed information regarding your absence on the automated system of the Medical Workforce team.
All junior medical staff are contractually obliged to maintain contact with Medical Workforce and their line manager/s during any period of absence and to keep them regularly informed regarding your expected return-to-work date. It is not acceptable for Medical Workforce and the On-Call team to have to repeatedly chase an employee regarding their sickness absence and return-to-work date.
Further details regarding Sickness Absence can be found in the relevant section of the Medicine On-Call Policy
The full Sickness Absence Policy for junior medical staff can be downloaded here
Below are some helpful pointers and requests to keep patients safe, help the AMU run smoothly and make all our working lives more productive. Further details are provided in the Medicine On-Call Policy.
When clerking during an on-call shift please…
- ► act within your own competence and don't hesitate to ask for (senior) advice whenever you are unsure
- ► familiarize yourself with and use our guidelines and pathways to standardize management of common presentations to AMU
- ► assign yourself to every patient you clerk on the MSS system and add the patient to the post-take list for senior review immediately after clerking
- ► present / discuss ALL patients clerked with the on-call consultant or RMO1; please DO NOT leave patients without senior review and DO NOT delay senior input into patients causing clinical concern whilst you complete a full clerking or wait for investigation results
- ► ensure that all investigations are performed in a timely manner; x-ray will not 'send' for patients on AMU - ask their nurse to arrange for a porter to take them to radiology; urgent US / CT / MRI scans will not happen urgently unless you discuss them with the relevant radiologist
- ► review the investigation results of ALL patients you have seen before the end of your shift (or ensure handover for these to be reviewed)
- ► progress the management plan and/or discharge of ALL patients you have seen and communicate this plan to the relevant nurse
- ► go back and review unstable / deteriorating patients you have clerked; escalate any unexpected deterioration or significantly abnormal investigation results to a senior clinician IMMEDIATELY
- ► add all patients requiring input fom a medical specialty (Respiratory, Gastroenterology, Renal) to the relevant specialty post-take list on Concerto; for urgent specialty review / advice, a telephone conversation is necessary; the daily on-call specialty rota for BHH can be downloaded here.
- ► ensure accurate handover of unstable patients and outstanding tasks to the incoming on-call team or receiving ward team (for patients transferring off AMU during normal working hours)
When AMU is full and you are clerking patients in the Emergency Department please...
- ► take blank copies of the AMU Clerking Booklet from the doctor’s office on AMU with you to use in ED (you will have to manually enter the patient’s name and PID on every page)
- ► prescribe any urgent drugs or fluids required in ED on the ED paperwork or a paper drug chart
- ► admit the patient onto the EP system (using the JAC Medicines Management application > Nurse Administration > APAT and selecting H20AMU as the default ward for admission) and prescribe all the drugs that the patient requires during their admission; it is unsafe to expect somebody else to prescribe these medications when the patient arrives on a ward
- ► ensure that you handover any patient that you have clerked in ED who is causing clinical concern or has outstanding investigations to the team on AMU (or receiving ward for direct transfers) if you will not be able to follow these up yourself
- ► ensure that patients you have clerked in ED are added to the post-take list on AMU for senior review (if not already reviewed in ED) and that you assign yourself to the patient on MSS once they arrive on AMU (to avoid duplicate clerking by another doctor)
When requesting investigations (radiology, cardiology etc.) please...
- ► ensure that the consultant name on the request form is the name of the consultant who has seen the patient most recently and / or instructed you to request the test (electronic requests will often default to the name of the on-call consultant which should be changed unless the patient has not seen any consultant prior to requesting the investigation)
- ► keep a log of and follow-up on the results of any urgent investigations and / or ensure that the consultant named on the request form is aware and has agreed to follow-up the results (especially for outpatient investigations)
- ► DO NOT ask the patient’s GP to chase up results of tests which were requested in hospital
- ► document in the medical notes when you have requested important investigations and make copies of paper request forms or referral slips to file in the medical notes
When discharging patients and writing TTOs please...
- ► write a TTO using the EP system for ALL patients (even those who self-discharge) BEFORE they are discharged from the ward; one copy of the printed TTO should be given to the patient, one copy filed in the medical notes and a further copy sent in the post to the patient’s GP
- ► change the consultant's name at the top of the TTO to the consultant who is actually responsible for the patient at the time of discharge (using the JAC Medicines Management application > Nurse Administration > CONPAT); alternatively write clearly in the text of the TTO 'discharging consultant was Dr..........'
- ► include a precise primary diagnosis (generic statements such as ‘non-cardiac chest pain’ or ‘headache’ are not adequate), important comorbidities, a brief summary of significant investigation results and management as an inpatient, further investigations requested as an outpatient (see advice above), arrangements for follow-up, any actions required by the GP and any advice or information given to the patient and / or their family
- ► document ALL medications supplied to the patient at discharge on the TTO, even if these were provided using a blue Boots Pharmacy prescription or from the TTo cupboard on AMU
- ► if no changes were made to the patient's medications as a result of their admission, please write this clearly on the TTO e.g. 'No changes were made to their usual medications'
- ► provide clear information on the TTO regarding any medications that have been discontinued in hospital and the reasons behind this
- ► ensure that you take full responsibility for arranging any outpatient follow-up required as otherwise it will NOT happen; if you are not sure how to arrange follow-up with a particular specialty / clinic, please ask somebody
And finally, please enjoy your on-calls and time on AMU!