WELCOME Medical REGISTRARS!
As a Medical Registrar working on the take here at Frimley, you play a vital role in ensuring the front door of the hospital works and that patients flow safely and efficiently to the most appropriate clinical area.
At the same time, your take shifts play a crucial part in your GIM training. We want to do everything we can to ensure the time you spend on-call is just as educational as the time you spend in clinic or on your base wards.
To ensure things go smoothly for your first shift, we'd ask that you familiarise yourself with our core principles and the key standards we expect our medical registrars to meet when working on the acute floor.
Once you've covered that, you can move on to our induction section, which should answer any burning questions you have. You can also find advice about how to prepare for your first shift and what your first shift will look like.
Crucially, there's a section here on where to get help if you need it. Frimley is a supportive hospital and help is always available if you're in a tough spot.
On behalf of the consultant team, welcome to Frimley and we look forward to working with you over the next year!
7 KEY STANDARDS
Here at Frimley, we expect our medical registrars...
INDUCTION
You should receive a formal induction before your first shift. Below are some commonly asked questions.
BEFORE YOUR
FIRST SHIFT
Please familiarise yourself with the principles and standards above - these are vital to understanding how the take at Frimley works.
Use the guides below to set up the medical take list on your EPIC login and familiarise yourself with the admission navigator in advance. These steps are essential to ensuring your first shift runs smoothly.
BLEEPS & TIMES
There are three medical registrars on-call in each 24-hour period. Their roles are described below.
Day
Bleep 5371
08:00 - 21:00
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Takes referrals from ED
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Takes referrals from local rehab hospitals
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Leads the medical take team
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Covers 2222 calls until 13:00
Twilight
Bleep 5120
13:00 - 00:00
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Provides ward reviews where requested
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Provides advice to other specialties
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Covers 2222 calls until 00:00
Night
Bleep 5371
20:30 - 09:00
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Takes referrals from ED
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Takes referrals from out-of-hours GPs
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Takes referrals from local rehab hospitals
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Leads the medical take team
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Covers 2222 calls from 00:00
A Day on Take
08:00
Morning Handover - SDEC/PGEC
We meet in either Medical SDEC (weekdays) or the Postgraduate Centre (weekends) to discuss patients from the night take and see who is suitable to pull to SDEC. The night registrar will hand over any unwell patients - and the bleep - to the day registrar.
08:30
Start the Day - ED Majors
The day registrar will return to their dedicated computer in ED Majors, located opposite the ED consultant. Check the medical take list to see who is waiting to be seen and set up the medical take team chat. If you identify any issues with staffing (for example, resident doctor sickness), escalate these to a consultant or to medical staffing directly.
09:00
Arrest Team Huddle - PGEC
The day registrar should attend the arrest team huddle, which will also be attended by the ITU consultant, outreach team and the on-call residents (FY1 and SHO). You will be the designated team leader and should assign roles to the team.
AM
Clerking & Take Management
The day registrar is responsible for ensuring patients are picked up promptly by the take team. You should follow the instructions above to ensure that patients flow smoothly across the acute floor. You may need to leave ED to attend emergency calls but should return as soon as possible. If the post-take consultants finish the night take, they will begin reviewing day patients.
13:00
Afternoon Touchpoint - ED Majors
When the twilight registrar arrives at 13:00, there will be a brief meeting between the two registrars, including the GIM consultant on for the late shift. This is to identify any staffing issues and ensure that there is a plan in place for managing flow through the afternoon. The twilight registrar should then give the day registrar a bleep-free lunch break.
PM
Division of Labour
The day registrar covers the take, while the twilight registrar covers ward reviews and attends emergency calls. The take will become progressively busier as the shift runs on, but several more resident doctors will arrive to join the take team. There are at least two consultants post-taking until 17:00 and at least one post-taking till 21:00.
20:30
Evening Handover - PGEC
Both the day registrar and twilight registrar attend this meeting to hand over patients to the night registrar, with a particular focus on any unwell patients or those who may be dischargeable overnight. This meeting is also attended by the night residents and the overnight outreach team. The day registrar hands the bleep over to the night registrar.
LATE
Division of Labour
The twilight registrar remains responsible for emergency calls until the end of their shift at midnight, while the night registrar takes over the medical take from the day registrar. Several of the late residents will remain till 10pm or 11pm, but will steadily hand over their patients and leave.
00:00
End of Shift for the Twilight Registrar
The twilight registrar finishes their shift at midnight. Before leaving, they will hand over any unwell patients on the ward to the night registrar. After this time, the night registrar is solely responsible for both ward patients and the take until the day team arrive at 08:00.
THE TAKE TEAM
Frimley has a particularly busy medical take and the take team here may be a lot bigger than you're used to if you've worked as a medical registrar elsewhere.
Shifts are structured so the majority of your team joins during peak times (13:00 - 23:00).
The Take LIST
The link to set up your medical take list is included below.
For medical registrars, there are a few additional steps you need to be aware of, mostly at the end of your shift.
At the end of a take shift - prior to handover - you should:
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Ensure "Consults to the Medical Take Team" have been marked as completed for all patients who have been clerked during your shift.
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Ensure all patients who have (a) been post-taken by a consultant and (b) left ED for a bed space on the ward are removed from the list to prevent bloat.
WHO ATTENDS EMERGENCY CALLS?
The day registrar attends NEWS calls and arrests until 13:00, when the twilight registrar takes over. From 00:00 (when the twilight registrar goes home), the night registrar attends these.
There is an important exception to this: if there are two calls in quick succession between 13:00 and 00:00, it's expected that the take registrar will attend the second call.
The registrar leads the team, but will be supported by our experienced outreach team and (during the day) the ITU consultant.
WHAT IS MADU?
MADU (Medical Acute Dependency Unit) is the area where we look after the sickest patients admitted under Medicine.
What does MADU do?
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Non-invasive ventilation (CPAP and BiPAP)
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Arterial lines
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Higher level monitoring
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Cuff-down tracheostomy care
What doesn’t MADU do?
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Optiflow
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Invasive ventilation
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Inotropes
Which patients should I consider for MADU?
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All patients requiring non-invasive ventilation
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Patients requiring higher levels of monitoring
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Diabetic ketoacidosis
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Status epilepticus
Who decides who comes to MADU?
In-hours (08:30 – 17:30), you should discuss potential patients with the MADU consultant on 133722.
Out-of-hours, the medical registrar gatekeeps beds on MADU. If you feel someone is appropriate, you should liaise with the MADU nurse-in-charge and bed managers to arrange transfer from ED or the ward.
The MADU senior nurses are very experienced and can help guide you if you’re unsure.
HELP!
As a consultant body, we know that the medical registrar can be a very challenging and mentally draining job. Many of us trained at Frimley and worked as registrars here ourselves.
Our aim is to support you to excel and - wherever possible - enjoy the role.
Between 08:00 and 21:00, there is at least one consultant post-taking in ED, with additional support from acute medicine consultants based in SDEC and on AMU. We are always happy to be asked questions or to help out if you're struggling.
Between 21:00 and 08:00, there is a medical consultant available at home. You shouldn't hesitate to call them if you need urgent help - the only calls you'll regret are the ones you didn't make.