Trauma and Orthopaedics induction booklet was contributed by the following;
written by Dr Emily Palmer
reviewed by Mr Maneesh Sinha
updated by Laraib G. Khan
Select the booklet titles below to expand the table to view more information.
T&O Ward Timetable and Meetings
| Day | Monday | Tuesday | Wednesday | Thursday | Friday |
|---|---|---|---|---|---|
|
AM |
Ward |
Teaching |
Ward |
Ward |
Ward |
|
PM |
Ward |
Ward |
Ward (Registrar and Consultant in clinic off-site) |
Ward |
Ward (Registrar and Consultant in clinic off-site) |
The rota for T&O is generated every Friday for that week, however it can be sent on the Sunday evening. It will be posted on the T&O WhatsApp group, and on Medirota so make sure you’re added when you start. Any day you are not on-call or on a rest day, you will be working Monday to Friday, 8am to 5pm.
Your on-calls are determined through the GIM rota and available through Medirota, all FY1s are on the same rota for on-calls. Please see the separate booklets on medical and surgical on-calls for further details. It is worth noting that there is a separate Medirota for your T&O rota and your GIM on-calls.
It is useful to send a spreadsheet of your on-calls and rest days to the following to ensure appropriate cover is arranged when you are not there;
T&O secretary | Raj Sonsana – raj.sonsana@nhs.net
Rota coordinator | Mr Muneer – azhar.muneer@nhs.net
TRAUMA MEETINGS
The trauma meeting starts at 8am in the “Pod” (on the first floor, between B4 and B3). You may or may not have access with your ID card.
The trauma meeting is attended by the SHO on-call and all other SHOs on that day. The consultant on-call will be present, as well as his registrars. They will discuss all of the new patients admitted from the emergency department and some ward referrals. It is not mandatory for the FY1 doctor to attend the trauma meeting, as the SHO’s present will hand over any jobs discussed. You can attend as a learning opportunity if you wish, however you may find the time better served preparing for ward round on your station.
The most useful thing you can do if you do attend is to listen out for the new patients admitted with neck of femur fractures.
The geriatrics SHO will be looking after those on B2 station 3 and you will be looking after those on B2 station 4. You may also be handed over some jobs from the night regarding patients on B2 station 4.
Trauma and Orthopaedic Ward
Your role on the Ward
Your role as the T&O FY1 is to work as part of the orthogeriatric team under the orthogeriatric consultant Dr Michael. At present, you only look after patients with neck of femur and proximal femur fractures. The best way to identify which patients are yours is to ask a friendly nurse on your station for their handover.
You do not look after patients with peri-prosthetic fractures, other T&O patients, or any outliers from other specialties, however you will be expected to review if any of them fall acutely unwell and escalate to the relevant team.
The normal day starts with a ward round at 9:00am
Ward Rounds
The normal day starts with a ward round at 9:00am on B2. The orthogeriatric team is spread over 2 stations: a geriatrics SHO on station 3 and an FY1 (you) on station 4. The registrar and consultant work across both stations, with the registrar also responsible for orthogeriatric patients on outlier wards.
The ward round starts on different stations on different days; on most days patients will be seen by either the consultant or registrar, however you may have to do your own ward rounds if neither are available. When doing your own ward rounds, it is helpful to communicate well with nursing staff to identify any issues with patients overnight to help guide your assessment.
Many of the patients will be straightforward and not require much intervention from you, however if there is anyone you are concerned about you can speak to the SHO on station 3, the registrar, or contact Dr Michael himself through switchboard. In an emergency the T&O SHOs are also very approachable for advice.
Documenting a ward round
Dr Michael (orthogeriatric consultant) has a specific way that he likes the ward round to be documented.
The ward round is now done on Sunrise: ‘click enter document‘, then search for ‘ward round‘. Fill in the details at the top for reviewing doctor, grade and specialty. If the patient has had a ward round document from the previous day, the ‘Diagnoses’ and ‘Current problems’ can be copied over (this saves a lot of writing time); you need to ensure this is updated for the present day. If you are unsure of the structure of documentation at first, look at a ward round completed by the previous FY1 for guidance.
Drug chart information can be found on Sunrise under orders, for fluid balance and for stool charts please review the patient’s bedside nursing notes (found either in the bays, by the side rooms or on the stations).
Dr Michael may ask you to join the ward round on station 3, in which case your main job will be to write a jobs list for the SHO. On station 4, you or the registrar will present the patients to the consultant, write in the notes and make a jobs list. Perform the jobs after the ward round.
Trauma and Orthopaedic Staff Roles
Your role on the Ward
The main jobs include:
- Prescribing
- Requesting bloods and scans
- Reviewing bloods
- Occasionally making referrals to other teams.
TTOs
I would recommend starting to write the clinical summary section of the patient’s TTOs as soon as they are admitted, as it can be a rush to get them done once they’re made medically fit for discharge. If you do prepare TTOs in advance, be mindful to ensure they are updated before the patient is discharged.
TTOs are completed on Sunrise. Specifically, for your patients you must include the FRAX score in the clinical summary and any follow-up in the ‘Hospital to action’ section of the discharge details tab. If you are unsure of follow-up needed, refer to Dr Michael’s first entry, as well as the pink operation note for any additional follow-up required by the operating T&O consultant.
The T&O SHOs currently work to a ward-based system. In addition, each T&O Consultant has a team SHO assigned to cover their patients for any specific concerns, which need to be escalated and addressed by a particular team.
Orthopaedic Medical Staff
The T&O SHOs currently work to a ward-based system. In addition, each T&O Consultant has a team SHO assigned to cover their patients for any specific concerns, which need to be escalated and addressed by a particular team.
There will also be Physician’s Associates on the T&O team. The T&O SHO/PA assigned to station 1 will also be covering station 3 T&O patients and station 2. SHO/PA cover station 4 for neck of femur fracture patients in the acute stage or non-neck of femur fracture cases. There is always a T&O SHO on the ward , who will assist with prescribing tasks and clinical reviews.
There is a consultant led T&O ward round every day covering all stations. The start timing of this can vary as they can start on the ward or with outliers/patients in HDU or ITU or Surgical assessment unit (B5). The T&O consultant on ward rounds will review neck of femur patients within the first 48 hours of admission and surgery, but any surgical issues such as wound healing problems must be flagged up to the T&O team even if after 48 hours of admission.
If there are any problems with the work load or the rota, speak to Mr Muneer. You will not routinely be scheduled to attend theatres, however if you have an interest in orthopaedics I would recommend making this clear upon starting and requesting theatre time allocated to you. You may also request to attend clinics; however, both of these activities are dependent on there being sufficient SHO cover for your station.
Remember to leave a note on Friday on station 4 for the orthogeriatric consultant who comes around at the weekend. They will only review patients that are acutely unwell or have not been seen yet within their admission. Other jobs or unwell patients can be handed over to the T&O SHO by bleeping the on-call SHO and verbally handing over, this is good medical practice and handovers over WhatsApp should be avoided.
Orthogeriatric Consultant
Remember to leave a note on Friday on station 4 for the orthogeriatric consultant who comes around at the weekend. They will only review patients that are acutely unwell or have not been seen yet within their admission. Other jobs or unwell patients can be handed over to the T&O SHO by bleeping the on-call SHO and verbally handing over, this is good medical practice and handovers over WhatsApp should be avoided.
Bleep
FY1s on Station 4 are not routinely expected to carry a bleep. However, it is good practice to alert the nurse in charge/nurse for station 4, if you are going on a break and roughly when you will be back.
T&O - Further Information
M&M Summaries and Death Certificates
When a patient dies, the T&O team require the responsible SHO to fill out an M&M form. This will normally be the SHO who does the death certification However, if a NOF patient passes away, it’s probably best to liaise with the relevant SHO to make sure that it gets done. If one of your patients should pass away while you are caring for them, you may be expected to go to the bereavement office to complete the required paperwork following their death. I would recommend discussing each patient with Dr Michael so you have a clear idea of what condition to put as cause of death, however there is also a medical examiner present in bereavement with whom you can discuss cases. Due to your patients presenting with neck of femur fractures and having surgery, most if not all of the deaths will require a coroner’s referral before a death certificate can be filled. The staff in the bereavement office can help you with this process.
Applying for Leave
Leave applications should be submitted to Raj Sonsana (T&O secretary, email raj.sonsana@nhs.net, her office is in the north block to the left of the education centre). This is done via Medirota, but I would also recommend emailing her to confirm the dates you have requested. There is a maximum of 2 SHOs off at any time, so I would recommend applying for leave as soon as possible, before you start this rotation if possible, but at least 6 weeks in advance.
If there are any urgent requests or you experience any problems, speak to Mr Muneer. You should also contact Raj via email or WhatsApp if you become unwell and are unable to come to work, as well as notifying Dr Michael and the nursing staff on your station.
Teaching
Russells Hall Hospital (RHH) foundation teaching is organised by the post-graduate department in RHH. You will receive information about this through the post-graduate co-ordinator via email. On Tuesday mornings you will be expected to go to your teaching at RHH as you need to attend a certain number of hours (30 core hours per year).
The timetable for this teaching is sent out weekly by the post-graduate department by email, so check these! A timetable is also printed out on the education board in the post graduate centre. In general, the teaching time each Tuesday is from 10am to 1pm. If there is no formal teaching scheduled for that week, you may use the protected time to work on self-directed learning or your portfolio.
On trauma and orthopaedics, you will have a T&O SHO cover on Tuesday mornings to go on the ward round on station 4 so you should be able to make all of your teaching sessions. I would advise reminding the rota coordinator Raj Sonsana of this before starting the rotation or as early as possible to ensure this is factored into the rota. This is protected teaching time that you are entitled to attend, so they should be accommodating this.
At present there is also T&O departmental teaching provided to juniors on Thursday afternoons – this can be confirmed on starting your rotation via the WhatsApp group. This teaching is given by registrars and SHOs and covers a wide range of key presentations in T&O. If you wish you may put yourself forward to present a topic for this teaching – speak to the registrar responsible for organising it at the time to arrange this. Any teaching you attend for this will count towards your non-core teaching hours on Horus.
