On the Phone
The goal at this stage is to risk stratify. Essentially, you want to determine how worried you should be about the patient. Is it a “drop everything and run” kind of patient or is it a “see after finishing current tasks” kind of patient? This is arguably the most important step as it’ll determine the speed of your actions and so the final outcome. Always have a low threshold for going and assessing patients. If someone is worried enough at 1am to pick up the phone about a patient, then it’s likely that something’s going on.
1. Identify reason for the call and why the nurse wants you to come over.
This primes your mind to start risk stratifying.
2.Ask about the patient’s background including reason for current admission and past medical history.
This allows you to formulate differential diagnoses right from the start and gives you a good impression of their recent and longer-term health status.
3.Ask for patient observation readings.
Importantly, ask for: heart rate, temperature, oxygen saturations, blood pressure, ECG readings. These provide an objective measure of how well or unwell the patient is and is invaluable in determining the speed of response. However, don’t forget to ask about the patient’s concerns and worries. No one knows the patient as well as the patient themselves. We are often guilty of just listening to nurses’ concerns and listening to obs readings, without taking a moment to ask how the patient is feeling in themselves.
4.Use all of this information to risk stratify the patient.
It might be useful to stratify the patient into these broad categories: “Needs immediate senior input and escalation”, “Needs immediate assessment”, “Needs non-urgent assessment”. The moral of the story is, whatever you do, the patient needs to be assessed by you at some point, the risk stratification helps you decide how quickly.
5.Look out for alarm bells.
These include rapid changes in their consciousness, rapid downward spiral of observation readings (very low blood pressures, spiking temperatures, abnormal ECG readings) and importantly patient concerns.
