Obstetrics and gynaecology induction toolkit [Pilot-live]
Keep a piece of paper with you to jot down referrals and queries – there will be too many to remember otherwise. Once you’ve dealt with something, cross it off so you can easily see what tasks are still pending. You can also use the back pages of the handover sheet, which now includes referred emergencies.
At times, you might receive multiple calls while already on the phone or reviewing a patient. Write down each number that appears on your bleep and return the calls in the order you received them, after finishing the original task. Some callers may sound frustrated – this isn’t personal; they may have been waiting for some time in the switchboard queue. Be kind, thank them for holding, and continue with the call.
If you accept a patient for review, ask them to come as soon as possible to help manage your workload and prevent a build-up at the end of the day. If a scan is needed, ask them to come with a full bladder. If there’s a chance they might need surgery, advise them not to eat or drink anything. Inform the GTA nurses with the patient details (name, CHI, presenting complaint, and whether a scan request is needed, which they can usually do for you).
Although it may be tempting to schedule patients for the next few days when things get busy, try to handle the referrals on the same day rather than booking them in for later. Be mindful that how much your colleagues have booked in advance can impact how busy your day will be.
For referrals from GPs or other specialties about patients previously reviewed by Gynaecology or with recent imaging, take time to check previous letters or results. This may mean calling the referrer back (request their direct number if possible to save time). While it may seem quicker to accept the referral immediately, reviewing past records allows you to provide more informed advice and may help clarify any misunderstandings about previous scan results.
While most referrals are appropriate, some may not be urgent or require immediate attention. If you're unsure, politely mention that you’ll discuss it with your consultant and get back to them. Take note of the patient and caller details (ideally, a direct number) and follow up after consulting with the on-call Consultant.
If there are potential CEPOD cases during the day, call the Consultant on-call early, especially if the patient is critically ill or if negotiations with other specialties for CEPOD access are needed. Anticipate and plan for cases in GTA to avoid a build-up of patients waiting for you after theatre. Involve the on-call Consultant to maximize efficiency.
It’s tempting to add “follow-up in GOPD” for patients with vague or long-standing symptoms, but this may not always be necessary. If a GOPD follow-up is needed, clearly state in the discharge letter why it’s required (e.g., for assessing treatment response). If you believe the patient doesn’t need further gynaecological review, discharge them to their GP, who can make an outpatient referral if necessary. Not all patients with an ‘interval scan’ (e.g., cyst monitoring) require a GOPD appointment; the on-call Consultant can request this if needed.
If another specialty in Lothian (usually RIE or WGH) contacts you for a review, you'll need to go to their ward. If you’ve only provided advice (e.g., asking them to arrange a TVUS for PMB), document it in the “clinical notes” section of TRAK with your recommendation.
Unless a patient is acutely unwell, avoid seeing new patients at this time. Instead, complete any remaining tasks, administrative work, or communication duties (e.g., MDM referrals). Ensure all documentation for patients you’ve seen is complete, which helps you leave on time and avoid passing tasks to the evening doctor who may not be familiar with the cases you’ve handled.
Before the shift ends, check in with the daytime Consultant to ensure there are no outstanding tasks and that everyone is aware of any high-risk or unwell patients.
Highlight any patients who are sick or may become unwell overnight. This means checking with the ward doctor for updates before handover.
Try to leave at least one bed available for out-of-hours emergency admissions. If bed availability is tight, consult with the on-call Consultant to identify which patients could be boarded out to free up space for urgent referrals.
If a patient doesn’t need immediate attention, place their details in the triage referral ‘folder’ (the pink folder in the drawers under base A in Ward 210). The nurse in charge will triage these the following morning, and the patient will be called with an appointment time.
You no longer need to request scans for these patients, as the nursing staff will handle this if needed, and the information will be included in the referral sheet.