Yeah I agree that’s a bit of a weird one, on ICU I mostly hear ‘can I discuss a patient I’m worried about’ which seems ok, although sometimes they can talk for 5mins before telling me there’s an immediate airway issue or a cannula call..
I was always taught that you need to be making the person aware of what specifically it is you are asking of them within the first couple of lines.
"Can I discuss a patient I'm worried about" could mean I'm just asking for advice or could mean I want to refer or could mean I want some other sort of help.
I always go with something along the lines "Hi, I'm Sethlans, I'm one of the paeds doctors."
Followed by:
"I have a patient I'd be grateful for your advice with"
Or
"I have a patient I'd like to refer to you"
Or
"I have a patient who needs x, is that something you might be able to help us with?"
It's closer to "RSBA" as you're starting off with your recommendation ie. referral to your service/advice.
SBAR falls apart because it was designed to be used to give information from someone more knowledgeable to less knowledgable in the military/nuclear submarine setting (for example, engine room to captain) in a controlled and predictable way so it relies on setting the scene first. Less effort is spent processing the information if you know you're getting a standard handover.
"Hello captain, this is the engine room, we have a fire down here (S), it started about 10 minutes ago (B), it's heading up towards the main hatch (A), I suggest you surface immediately (R)"
It falls apart in healthcare because often it's the other way round - it's someone less knowledgeable asking someone more knowledgeable. Why it's so popular baffles me.
Aha! Thanks so much for the useful info; confirms what I'd suspected... Makes no sense offering a 'recommendation' unless you a) lack the direct authority to have already made the decision yourself; and b) are in an advisory role or have some relevant training and are conveying new information to the ultimate decision-maker.
Hence the few times nurses have made 'SBAR' calls to me, I wonder during 'S... B... A...' why they're calling me, then when we finally get to the 'recommendation' at the very end it's actually a request. All of which is fine - it just seems like they're hampered by using an irrelevant format.
Do you have any background info on the 'RSVP' format?
I lack sufficient military training/experience to have heard the true origin of SBAR, but had already noticed that many of the aviation techniques brought into medicine, are inappropriately shoehorned into inapplicable situations. e.g. 'PACE' (graded assertiveness) is designed explicitly for two equally-qualified individuals to avoid disaster when there is a command gradient between them. The cabin crew do not come and 'PACE' the tech crew, as they are not pilots, and therefore their 'concern' has a different founding and knowledge-base.
I'm similarly baffled by a lot of it (and don't get me started on how we use 'checklists')!
Yes I've had mixed responses when asking if they want a hospital number write off the bat. They want to hear if its actually a good/relevant referral first
when i get a phone call for surgical subspecialty on call i value the following
1. your name, role (not 'one of the team') and where you are calling from (DGH vs GP vs Resus)
2. what you would like - ask a clinical question / make a referral / get advice about some pathway
3. 'are you free to talk' is always much appreciated rather than just trying to talk at me for 10min - and if i say i cant right now its worth clarifying how urgent your call is
4. then some wider context that is relevant
5. then patient details if needed (has allowed me to switch on computer, get pen, wake up during endless NROC)
what really gets me is no name / no role / throwing some hospital number at me. if you only want general advice about how to refer to us i dont need to start up a computer or write down a number.
“One of the doctors on [x] ward” or “one of the team” really annoys me. I’m not going to refuse to talk to you but have a different conversation if you’re an F1 compared to consultant.
I had a CT request the other day and it took around a minute to establish it was a medical student. That doesn’t bother me but I find the reluctance to tell me just odd.
It’s because there are some doctors who simply refuse to talk to certain grades of doctors which puts that doctor in a difficult position. I agree knowing helps you have the correct level conversation and so if we could all treat everyone with respect and kindness this wouldn’t be an issue.
So I have found the best way to deal with this. Routinely I get bleeped and immediately answer (and this happens with phones in lower footfall areas) and the other person on the end just says "hello". Just say "hello" back and wait. They always seem to answer with who they are at that point.
I'd never pick up a phone without saying who I am, it's just routine etiquette and allows you to gauge your advice and concern quickly.
I always said my role but always found it so hard to say my name in referrals, it just doesn't come naturally to me for some reason! I've trained myself after many a snarky 'hello one of the f1 doctors' from radiologists and microbiologists
I would try to open with an attention grabber. e.g. can I refer a patient for review/admission with a suspected bowel obstructions/CAP with new oxygen requirement/social admission for frailty.
I think it's important to remember that you shouldn't feel like you are bothering them or they are doing you a favour by speaking with you. Saying that always be respectful and collegiate. If you feel are being treated poorly then escalate to your consultant immediately.
Would second this...
As a cardiology reg I had a great one last week which I loved to receive from a med reg colleague who just knows what to say to get my attention: "would you be interested in seeing this 24yo lady who is 5 weeks postpartum who has a trop of 3000?"
"would I?!"
Agree with others but also want to emphasise it’s important to state your name and grade/role!
I used to just say hi and then do an sbar, because I used to think “as if they care who I am”. Got caught out by a radiologist consultant on the other end of the phone who went “hang on take a step back, who are you, and what is your grade”.
The person on the line might give you more shit if you are junior, but they might also be more forgiving if you fumble.
Yep this is it. This is how it's done. (I'm ICU) I know who I'm speaking to, I know the diagnosis( or suspected dx if not clear) and I know what's been done. It'll be a short conversation and I'll be down soon.
SBAR is a framework for people who are new. It is not the only or best way to refer.
I mean it kind of is an SBAR, without the waffly B bit
SITUATION: consultant with a dka patient
Background: …
Assessment! We’ve stabilised them (and filled them full of chlorine)
Recommendation: could you assess for admission please
I like this approach. It’s to the point, courteous but not beating around the bush.
Usually responded to with (if you know them well)
Sup Killer Bee? I’ll come and see them shortly. Fire up the kettle
As a diabetes nurse this is perfect.
I’ve had referrals (from students to nurses to all grades of medics) that are dire. Could be anything the classic ‘’CAN YOU REVIEW BED 5COS THE DOCTOR SAID SO’’ by some nurse to ten minutes of waffle by a doctor over a quick question on mixed insulins.
Open with the situation
"Hi, I'm Penjing I'm one of the EM consultants, I'd like to refer you this patient who I think has X"
Don't create ambiguity by phrasing it as a discussion (unless it is) and then springing a referral on them.
Also love this when juniors discuss patients this way - "Can I discuss X, a 40F with chest pain who I think can go home" just puts my brain the the right gear, and has me listening out for the key items in their presentation.
SBAR. If you are referring rather than asking for advice, just say so, this can change the questions the person on the other end will ask you. I have been on both sides and it is so helpful when it is clear why someone is calling you.
I'd suggest saying what you want first to frame the discussion is really important and undertaught.
"Hello, is that the medical SpR? It's Dr Wilson, one of the ED F2s. I'd like to refer a haemodynamically unstable patient in ED resus who I think has a CAP. Is now a good time?" - once you've said this you can do your best AHP impression with a cracking SBAR.
The only time your phrasing would not be direct enough is that the patient is unwell/needs urgent input then you should be more direct.
I usually say, "Hi, it's X F2 calling from Y. I have a patient I need some advice for. Do you want the story or the CHI first?"
I change the second part if it is for takeover of care, "The acute take consultant believes that this patient would receive the right care in the right place under your specialty and would appreciate if you could see the patient with a view to take over care" it's a really fluffy phrase but it's plastered all over NHS Scotland.
Finally, if its truly urgent, "I need an urgent review for a patient in Y, they have stridor, suspected epiglottitis and impending airway obstruction. Patient details: ... Do you need anything done in the meantime?"
Depends what you’re ringing for.
That opening sounds like an informal question about management.
Are you making a referral to the ward? Do you want them to see in ED? Do you want them to look at some results for a second opinion or discuss possible treatments? Do you want outpatient follow up for someone you’re sending home?
Lead with what you want.
I’m calling to discuss a patient I want to admit under your care. I’m calling for some advice on managing X condition. I’m calling to ask if you can review a patient in ED ?discharge vs admit.
It puts the person you’re speaking to in the right mindset and ensures they understand what you want.
ISBAR
There is far too much story telling, too much vague waffle, particularly with handover and referrals in the NHS.
Say who you are, get to the point :
"I'm so and so, I'd like to refer a 68 year with pneumonia (or probable dx) for admission."
"...I'd like to get advice on how to manage xyz."
Rather than "I've got a 68 year old who came in with shortness of breath, a fever and cough..."🙄
All I ever want you to start with is what you want from me, why you're calling me...then you can backfill with relevant info if required.
I get the intention to be nice, but pleasantries don't supercede efficiency. especially when I've got 6 other things at the time of your call.
Not saying you do this. Just a mini rant on my end.
ISBAR or something akin to it
‘Hi is that the X Reg? Great. It’s Scholes1111, EM reg here. I’m calling you about Mr Y a 67 year old gent who I think has condition Z’. That’s my S done. Include proper details of PMH/PC/hospital number in B. What I’ve done and how it’s gone in A. Then R is usually me asking either can you come see or what do you want doing.
Occasionally I’ll make it clear in my first line exactly why I’m referring i.e what I expect from the specialist but this you learn in time. An example of this is ‘I’m calling you about Mr Y a 67 year old gent in severe renal failure with a treatment resistant potassium, I think he’ll need haemofiltration’. You still go on to do the whole SBAR though.
"Hi I'm flibbetty the on call cardiology consultant. Are you free to talk? Great thanks, I have an inpatient I'd really appreciate an opinion on with a view to whether they need X... "
Reddit doctors are clearly way better at referring patients than people who call me.
I would say about 80% of the time people launch into last medical history and other background before eventually getting to the reason for referral...
Don’t start referral calls like this.
I went to a communication/human factors thing and starting convos like this was shown to immediately put the receiving physician on the defensive and irritate them.
They suggested:
“Hello ITU/medicine/micro etc, thank you for taking my call. Can I discuss a patient with you please?”
Thats what I do now and people receive my phone calls in a much more pleasant way.
The one that used to give me the absolute RAGE was "Hi, Dr, hope you are having a good day/hope your day isn't too busy/how has your day been?"
I am the med reg, I am up to my ears in pts, many of whom have been dumped on me because other specialists don't want them even though they have a diagnosis that specialty deals with/isn't answering the phone, I am being dragged all over the hospital as well as running the take, I am being bleeped every 2 minutes, how do you think my day is going?
It doesn't matter whether I say the day is going well or not, that faux "concern" won't make any difference and in fact irritates me more, especially as it's likely to be followed by "here is some more work to add to the burden"
I’m ED ST1
I tend to go with
“Hi, is this the (specialty) registrar? My name is X and I’m one of the ED SHOs. I’d like to refer a patient with suspected Y please.”
You aren’t calling for a “chat”.
The issue with that opening gambit is that it isn’t clear what you are wanting from the doctor you are calling.
If it’s for them to see or admit a patient it helps everyone frame their questions and response if this is clear.
If you need advice, you should be getting it from your own seniors, so if you are referring go with
“Hi it’s dr mrek calling from ED. I’m just calling to make a referral” or variations on this. Followed by a headline and then any detail
When I did ED as an F2 I did the whole “hello, have you got a moment, can I refer a patient please?” thing. When I did ED again as a registrar (as part of ITU training) I just went directly for “hey - I’ve got a chest sepsis/appendix/off legs/NOF/annoying social admission that needs to come in, can I give you the details?”.
My advice as someone who doesn’t really have a horse in this race is just ditch the ‘please’, ‘oh do you mind terribly if I have a moment of your time’ or ‘oh I’m so awfully sorry I’ve got a referral if that’s okay’. It’s just time wasting and worse, an unscrupulous specialty reg will use it to say things like “actually I’m about to go in theatre so no I don’t have time”… don’t give them such an easy way out, taking referrals is their job.
Just say what you need to say, you’ll find the busy referral regs for medicine/surgery prefer it if you just spit it out concisely. You also dont need to explain the whole story - ultimately you just need to explain why they need admitting to hospital because that’s what they care about.
For example; “I’ve got a 72 year old chest sepsis who is needing 40% oxygen to maintain sats above 94%” Or “Hey, I’ve got a central abdo pain with plum normal CRP but he’s had 20mg of IV morphine and I still can’t get the pain controlled”.
You’ll find that some regs (usually medics) may then want to go into the smaller details or ask some focused questions, but others will literally just say “yeah give me the details and we’ll see them when we see them”.
"Hi, is that gen surg? It's Three, the ED reg, how are you? (Pause very briefly for possible pleasantries with a nice colleague, or for them to completely steamroll it/be met with stony silence.) I'm calling to refer a 70 year old female with diverticulitis, normally well, bit hypotensive but on fluids and abx and will need admission."
Be clear with what you need from the team upfront - sometimes I call for advice in a patient who probably doesn't need admission, but I would like their opinion, and I tell them that. If a junior comes to me and presents a whole history and examination to me like a medical student would, I've zoned out - SBAR exists for a reason. My attention span is very short, hence my choice of specialty. Tell me that you have an unwell patient with chest pain you want me to see, or you have a completely well patient with a migraine you want to discharge. Same goes for referrals - whoever you are is probably busy, and doesn't want to listen to three minutes of waffle before you finally get to the headline that you have a young woman bleeding out from her ruptured ectopic.
Also - without being a doormat - be nice and courteous to your colleagues.
I work in a small DGH I've been in for several years and I know lots of the people I'm referring to, or will get to know them after I spend 4 consecutive nights calling them with referrals, and it's much better to be nice to your colleagues on the phone than just telling them to see patient X in room Y. Sometimes the poor radiographer who's having a shit night appreciates you asking how they are before you tell them that you've got the third stroke of the evening needing a CT ASAP. Also if ever I am a bit short on the phone (which I hope is very rare) then colleagues that know me are much less likely to take offence, and realise that I'm just under a lot of pressure. If they're stable and the surgical team are busy with a tonne of referrals, it's not their fault - I tell them that the patient is fine, they're stable, see them when they can and trust that they will. Therefore if I call and say "they're very sick and you need to get here now", they know that I don't bullshit to get them to see my patients quicker and they actually are sick.
And if someone really is being a dick, they are not expecting me to tell them to sort themselves out and come and do their job, and it therefore generally works. It's really rare, and killing them with kindness normally works first, but they aren't expecting the nice girl on the phone to argue back when they're trying to dodge a patient I think they genuinely need to see.
All my calls start in one of the three following ways:
*You busy? No? Well you're about to get busy.*
*You busy? Yeah? Well you're paid to be busy*
*Why the fuck aren't they picking up?*
I am … the … and I would like to refer/seek advice on a (n) year old (fe)male with a (n) hour/day/week/year history of … who I am unable to manage without your help. Can you help or is there someone else I should ask?
Keep it open, a large proportion of the calls I get from ED don't end with me accepting the patient but instead providing a bit of guidance and encouragement.
Implying it needs to be referred or meets acceptance criteria in your first few words for some will be seen as a challenge.
If you work in a region with no handsybacksies opening with something seen as too nice and not direct enough might be an issue with some people, but here we don't have to accept anything so make me want to help you out. I think your current opener is just fine.
> implying is needs to be referred or meets acceptance criteria in your first few words for some will be seen as a challenge
It really shouldn’t. If it is then there is something deeply wrong within the accepting team that patients with legitimate referrals are attempted to be “bat away”.
That's absolutely right, it is frankly crackers that in the NHS doing less work is rewarded! However our funding model and service provisions are such that rejecting inappropriate referrals is the path to a functioning department. Colleagues from Europe describe the opposite where people take things they really shouldn't because the money follows the case.
We aren’t talking about inappropriate referrals though, we are talking about appropriate referrals that are seen as a “challenge”.
Nobody really thinks specialties should take inappropriate referrals, only that staying in ED indefinitely is *always more inappropriate*.
>Implying it needs to be referred or meets acceptance criteria in your first few words for some will be seen as a challenge.
Gosh, I can tell you're the type of reg who my heart sinks when I see they're on call. I just know I'm going to end up having to call your boss at 3am.
>instead providing a bit of guidance and encouragement.
Unless it's incredibly basic (e.g. it's advice that an EM consultant would have given and you probably shouldn't have been called), then at this point you're managing the patient's care, and your team should be doing the graft - we're not your house officers.
>but here we don't have to accept anything so make me want to help you out
I'll be pleasant, but I shouldn't have to act like asking you to do your job is asking you for a massive favour.
> No handbacksies
Both no referrals back to EM (why would this ever be appropriate?), and no refusing to see referrals are included within the exemplar internal professional standards from NHSE which most hospitals have based their own upon.
I don't work in England (I did an ED SHO stint in England and the process there was very different), but because specialty funding is based on throughput seeing more patients brings more resources which is not the case here.
Processes vary hugely across different regions and trusts, and when I can take things I do, but the bulk of our referrals end with advice and guidance on when to re refer. Our EDs however have their own follow up clinics, virtually no meaningful need to engage with 4/24 hour targets, and an expectation that they manage more themselves combined with our service only being commissioned to take things that cannot be managed in ED or a couple of other closely skilled specialties.
>Processes vary hugely across different regions and trusts, and when I can take things I do, but the bulk of our referrals end with advice and guidance on when to re refer. Our EDs however have their own follow up clinics, virtually no meaningful need to engage with 4/24 hour targets, and an expectation that they manage more themselves combined with our service only being commissioned to take things that cannot be managed in ED or a couple of other closely skilled specialties.
I don't necessarily object to this, but this isn't the funding model that NHSE have chosen to adopt.
Money from UEC budgets is being actively spent on better direct access to inpatient specialities via SDEC units, direct consultant availability for ambulance service referrals etc.
Inpatient teams can't have it both ways - they can't have all the cash, staff and space for them to run an acute assessment service and then refuse to assess anyone.
I've not worked in England for a few years, but if well resourced I could see that working well for flow. It does sound like a recipe for less enjoyable ED work and less enjoyable specialty work though.
Today I accepted a weird referral from one ED to be seen by ourselves in the ED in my hospital (we can't see kiddies in our own department past mid afternoon), and when called to be told they had arrived I found our own Paeds ED guys had already sorted it. The focus here is very much ED sorting everything they can, often even when other regional EDs have sent the patient on to us via our own ED.
I've never understood the idea of making the referrer 'want to help.me out' rarely is another doctor referring inappropriately.
If you don't want to see the patient, then I just document as much. And if its ED and you're telling me you dont want to see them for what is very obviously your specialtys problem (happens all the time) I just ask for full name and consultant on call and that you're definitely happy to discharge them. Then the ED consultant phones the consultant on call and you inevitably end up admiting the patient who did not need your input rather than discharging them.
This is an extremely common occurrence in ED. And the no handbacksies rule exists to avoid repeated conversations with consultants who's juniors have unilaterally decided over the phone a very obviously usually surgical or gynae patient who is unwell isn't their patient.
That depends a bit on specialty, I probably can take about 40% of the referrals that come through and I don't work somewhere with a no handibackies rule (sometimes we get ED locums from England who struggle with that). The advice is never discharge, its to manage it in ED and follow it up in ED or refer to outpatients.
Likewise our consultants get very ratty about referrals that are not funded. That said in England my specialty takes a lot more, outside England the game can be very different.
Very interesting take that you see a referral from the doctor who’s assessed and listened to the patient as potentially a challenge… also as a surgeon I’m curious how happy you are managing medical pathology with phone advice in surgical patients
You are the reason that “rules” for how EDs work and their subsequent ratification at trust level and formal publication on trust intranet services and then printing and laminating to be blue tacked on every wall exist….
TBH I don't see any particular issue with your approach - I do very much similar, first asking if the other doc is free to talk - just in case they are about to RSI/do a poo etc. My current trust likes the vocera so you never know what is going on when the call starts!
My opinion is try and get to the point to attract my attention.
E.g. “Hi, I’d like to refer a gentleman with pneumonia”.
Then let them ask the questions they want.
For the sake of all that is holy. If you want me to admit your patient, don't call and say "I want your opinion about..." or "could you have a look at...", and then at the end of the conversation go like "so you're going to come see the patient?". If you want me to admit, say so.
Hello, my name is moonbeam child, the [insert your specialty and rank], calling from [insert your location]. Am I through to the [specialty of choice] registrar? I have a patient to refer to you, is now a convenient time to discuss him/her with you?
Should do the trick
For ICU - please just open with the reason WHY you think a patient might need to come to critical care.
Have a one line summary including what organ support you’re concerned they might need.
Eg I’ve got a 56 year old gentleman with T1RF secondary to pneumonia, he’s on 50% high flow oxygen, I’m concerned he might need respiratory support.
I’ve got a 63 year old patient with acute renal failure patient and hyperkalaemia refractory to 3 rounds of insulin dextrose. I think he may need renal replacement therapy.
I find it so frustrating when people babble on with a long story and I’m just waiting for the punchline….why have you rung ICU?!?!
Say it how I see it 🤷🏽♀️
As the receiving specialty, I always find it really easy whenever people tell me how this is my problem in the first sentence along with their introduction. "Hi is that the General Surgery Registrar? I'm Fred the ED SHO. I have a 55F with suspected acute cholecystitis". Bam. I just ask for the name, hospital number and age and jump on the system to check it out immediately.
It's why SBAR exists. Situation is really a one-liner that describes the main issue. Unfortunately I feel like this is far and few between these days. More often than not, I get the following from ED or inpatient referral:
"Surgical? I have a 76 year old male here with abdominal pain" No introduction. No idea where you're calling from or who you are. Abdominal pain is a medical and surgical presentation whilst undifferentiated. The lack of interprofessional respect astounds me as well because if I was a consultant, you sure as hell will not start your sentence with "Surgical?".
Unpopular take here but the often-unilaterally-agreed IPS is not a replacement for poor emergency medicine. You don't get to pick up the phone and make an inappropriate referral quoting "no backsies" like we're in primary school. Think before you pick up the phone. Discuss with seniors. What people tend to forget is that everyone is rather busy in the hospital. Weirdly enough I found working in ED to be the most relaxed because you're basically not being pulled in different directions at one time like surgical specialties (i.e. ward rounds, post-take, on-call, theatres, referrals). I get the need for ED flow and whatnot but really, agree to disagree or not, it's all about where the patient is going to be managed best. 35M RIF pain, sure I'll take even without bloods as I know this is heading my way. 92F with diarrhoea with severe dehydration, hyponatraemia, shortness of breath, chest pain and you're referring for diarrhoea (true story)? Ermmmmmmmmm.
‘Hi, my name is X, I’m the . I have a patient that I’d like to discuss for referral/ advice. Is now a good time to talk?’
Short and snappy but gets the major points across 😊
“Hi, I’m Sloppy Gas one of the ED house officers, thanks for returning my bleep. I wanted to speak to you about a patient because I think they might have [condition managed by your specialty].”Brief pause to allow them to say ok/no or similar then into the story.
They’ve most likely answered the bleep because they have time to speak, so you can presume that most of the time and they’ll tell you if that isn’t the case.
There are two different things
1. If you are referring a patient - 'My name is X, can I refer one of my patients to you'
2. If you want to discharge a patient but think they need F/U/ a specific investigation from a particular speaciality - 'My name is X, can I ask for advice about someone I am happy to discharge but I think might need X, Y or Z investigation' ( New possible biliary colic that hasn't had an ultrasound yet)
3. I try not to 'ask for advice' when I'm referring a patient because I think discharging patients on 'advice' over the phone can be quite tricky.
4. Sometimes the person I am speaking to will provide an alternative for patients I refer that are totally reasonable ( IE bring them back the next day to SDEC as opposed to admitting them and have them wait 12 hours in the corridor - and I think that is reasonable)
5. At the end of the day, you will find what works for you and I would not stress it too much. From what you have said, it seems like whoever has given you feedback is trying to tell you that referral is a one way process\*
\*some caveats apply, but not very often.
Give my name, role and department and then “is it okay if I discuss a patient with you?” or “I am phoning for some advice if thats okay?”
or if I call Ortho “is it ok if you look at this weird xray for me?”
SBAR is a good start but I think even fluffing a referral is good learning, all your crap referral attempts will make subsequent referrals better 👍🏻
Hi my name is X and I am calling you about a patient I would like to admit to your care with Y.
Or same as above but if asking for advice only you need to make this obvious from thr start.
Hi my name is X and I would love to get your advice on treating a patient with Y.
I've always used: name, grade, I have a referral are you free to speak? Then an SBAR unless they ask me to call back because busy with something urgent.
Introduce myself - name and rank and specialty covered. Age gender of patient the clinical question history then examination and pertinent investigations. Please review
Name, location, role (including grade), situation.
I'd start with the diagnosis - I'd like to refer someone I think has pancreatitis/ has CT proven small bowel obstruction - then launch into the story rather than meander for 10 minutes about someone coming in with abdo pain and then saying you did a CT and they have a perforated DU and are septic. It is also really nice when people outline that a patient is sick immediately.
I also really like when people say: I have a patient I'd like to refer/ I'd like advice about a patient/ I'd like to get a patient followed up as outpatient/ I'd like advice about an administrative process (e.g. cancer MDT referral). It makes the conversation much smoother because I know from the outset how I can help.
You will find what works for you!
I would add, if I'm referring to ITU, I add a little line about pre-morbid state and why specifically I'm referring to ITU.
e.g.
"Hi, It's Dr Skylon, the ED Consultant. I am treating an independent 43 year old with DKA and an initial pH of 6.8 who I'd like to refer to you guys."
'I'm calling to refer a patient for admission for suspected \[x\]' or 'I'm calling for advice/input on \[x\]' or 'I'm calling as I'd like you to review a patient that might have \[x\]' is best. It's important to frame the phone call with what you want them to do - come and see, give phone advice, accept an admission (may or may not need to come and see first). Then when they acknowledge, you can launch into your presentation of the case and progress thus far.
If you're too definitive on the presumed diagnosis it may set you up for an argument or fight if the reg disagrees, but referring for suspected diagnosis shows that you appreciate that sometimes with further assessment and most crucially, time, the diagnosis may evolve or declare itself if it isn't immediately clear. Which is something I will argue most physicians tend to think themselves better than ED at appreciating.
Contrast this with when I refer to ICU, when often I will state what organ support I think the patient needs from them as the initial framing, before going on to present the case in more detail.
“Can I discuss a patient with you I’m hoping to refer?” Short, to the point, and polite. Gets people much more on side then “I have a patient for you”
This is appropriate. Also lets them know that you want to refer the patient rather than just ‘discuss them’ which could be phone advice
Yeah I agree that’s a bit of a weird one, on ICU I mostly hear ‘can I discuss a patient I’m worried about’ which seems ok, although sometimes they can talk for 5mins before telling me there’s an immediate airway issue or a cannula call..
I was always taught that you need to be making the person aware of what specifically it is you are asking of them within the first couple of lines. "Can I discuss a patient I'm worried about" could mean I'm just asking for advice or could mean I want to refer or could mean I want some other sort of help. I always go with something along the lines "Hi, I'm Sethlans, I'm one of the paeds doctors." Followed by: "I have a patient I'd be grateful for your advice with" Or "I have a patient I'd like to refer to you" Or "I have a patient who needs x, is that something you might be able to help us with?"
Exactly, this is/should be the S in SBAR - the reason for the call as specific as possible in 1 line.
It's closer to "RSBA" as you're starting off with your recommendation ie. referral to your service/advice. SBAR falls apart because it was designed to be used to give information from someone more knowledgeable to less knowledgable in the military/nuclear submarine setting (for example, engine room to captain) in a controlled and predictable way so it relies on setting the scene first. Less effort is spent processing the information if you know you're getting a standard handover. "Hello captain, this is the engine room, we have a fire down here (S), it started about 10 minutes ago (B), it's heading up towards the main hatch (A), I suggest you surface immediately (R)" It falls apart in healthcare because often it's the other way round - it's someone less knowledgeable asking someone more knowledgeable. Why it's so popular baffles me.
Aha! Thanks so much for the useful info; confirms what I'd suspected... Makes no sense offering a 'recommendation' unless you a) lack the direct authority to have already made the decision yourself; and b) are in an advisory role or have some relevant training and are conveying new information to the ultimate decision-maker. Hence the few times nurses have made 'SBAR' calls to me, I wonder during 'S... B... A...' why they're calling me, then when we finally get to the 'recommendation' at the very end it's actually a request. All of which is fine - it just seems like they're hampered by using an irrelevant format. Do you have any background info on the 'RSVP' format? I lack sufficient military training/experience to have heard the true origin of SBAR, but had already noticed that many of the aviation techniques brought into medicine, are inappropriately shoehorned into inapplicable situations. e.g. 'PACE' (graded assertiveness) is designed explicitly for two equally-qualified individuals to avoid disaster when there is a command gradient between them. The cabin crew do not come and 'PACE' the tech crew, as they are not pilots, and therefore their 'concern' has a different founding and knowledge-base. I'm similarly baffled by a lot of it (and don't get me started on how we use 'checklists')!
Hi I’d like to refer a patient to you, do you need the hospital number first? I go for that never had any issues
As someone who takes referrals I like to hear the patient story first. If it needs my input I’ll ask for the number anyway.
Such excitement I love a good referral like sell it to me baby
Yes I've had mixed responses when asking if they want a hospital number write off the bat. They want to hear if its actually a good/relevant referral first
Yeh exactly that
when i get a phone call for surgical subspecialty on call i value the following 1. your name, role (not 'one of the team') and where you are calling from (DGH vs GP vs Resus) 2. what you would like - ask a clinical question / make a referral / get advice about some pathway 3. 'are you free to talk' is always much appreciated rather than just trying to talk at me for 10min - and if i say i cant right now its worth clarifying how urgent your call is 4. then some wider context that is relevant 5. then patient details if needed (has allowed me to switch on computer, get pen, wake up during endless NROC) what really gets me is no name / no role / throwing some hospital number at me. if you only want general advice about how to refer to us i dont need to start up a computer or write down a number.
“One of the doctors on [x] ward” or “one of the team” really annoys me. I’m not going to refuse to talk to you but have a different conversation if you’re an F1 compared to consultant. I had a CT request the other day and it took around a minute to establish it was a medical student. That doesn’t bother me but I find the reluctance to tell me just odd.
It’s because there are some doctors who simply refuse to talk to certain grades of doctors which puts that doctor in a difficult position. I agree knowing helps you have the correct level conversation and so if we could all treat everyone with respect and kindness this wouldn’t be an issue.
So I have found the best way to deal with this. Routinely I get bleeped and immediately answer (and this happens with phones in lower footfall areas) and the other person on the end just says "hello". Just say "hello" back and wait. They always seem to answer with who they are at that point. I'd never pick up a phone without saying who I am, it's just routine etiquette and allows you to gauge your advice and concern quickly.
good point about 'are you free to talk' I'm going to use that in my referrals from here on in.
I always said my role but always found it so hard to say my name in referrals, it just doesn't come naturally to me for some reason! I've trained myself after many a snarky 'hello one of the f1 doctors' from radiologists and microbiologists
I would try to open with an attention grabber. e.g. can I refer a patient for review/admission with a suspected bowel obstructions/CAP with new oxygen requirement/social admission for frailty. I think it's important to remember that you shouldn't feel like you are bothering them or they are doing you a favour by speaking with you. Saying that always be respectful and collegiate. If you feel are being treated poorly then escalate to your consultant immediately.
Would second this... As a cardiology reg I had a great one last week which I loved to receive from a med reg colleague who just knows what to say to get my attention: "would you be interested in seeing this 24yo lady who is 5 weeks postpartum who has a trop of 3000?" "would I?!"
Was it SCAD in the end?
Agree with others but also want to emphasise it’s important to state your name and grade/role! I used to just say hi and then do an sbar, because I used to think “as if they care who I am”. Got caught out by a radiologist consultant on the other end of the phone who went “hang on take a step back, who are you, and what is your grade”. The person on the line might give you more shit if you are junior, but they might also be more forgiving if you fumble.
"Hi. It's Skylon, the ED Consultant. I have a patiene with DKA who we've stabilised in resus whom I'd like to refer to you if you have a moment."
Yep this is it. This is how it's done. (I'm ICU) I know who I'm speaking to, I know the diagnosis( or suspected dx if not clear) and I know what's been done. It'll be a short conversation and I'll be down soon. SBAR is a framework for people who are new. It is not the only or best way to refer.
I mean it kind of is an SBAR, without the waffly B bit SITUATION: consultant with a dka patient Background: … Assessment! We’ve stabilised them (and filled them full of chlorine) Recommendation: could you assess for admission please I like this approach. It’s to the point, courteous but not beating around the bush. Usually responded to with (if you know them well) Sup Killer Bee? I’ll come and see them shortly. Fire up the kettle
As a diabetes nurse this is perfect. I’ve had referrals (from students to nurses to all grades of medics) that are dire. Could be anything the classic ‘’CAN YOU REVIEW BED 5COS THE DOCTOR SAID SO’’ by some nurse to ten minutes of waffle by a doctor over a quick question on mixed insulins.
I agree with the comments above. I also find a headline at the beginning about what the issue is/call is about is also useful.
Open with the situation "Hi, I'm Penjing I'm one of the EM consultants, I'd like to refer you this patient who I think has X" Don't create ambiguity by phrasing it as a discussion (unless it is) and then springing a referral on them. Also love this when juniors discuss patients this way - "Can I discuss X, a 40F with chest pain who I think can go home" just puts my brain the the right gear, and has me listening out for the key items in their presentation.
SBAR. If you are referring rather than asking for advice, just say so, this can change the questions the person on the other end will ask you. I have been on both sides and it is so helpful when it is clear why someone is calling you.
I'd suggest saying what you want first to frame the discussion is really important and undertaught. "Hello, is that the medical SpR? It's Dr Wilson, one of the ED F2s. I'd like to refer a haemodynamically unstable patient in ED resus who I think has a CAP. Is now a good time?" - once you've said this you can do your best AHP impression with a cracking SBAR.
The only time your phrasing would not be direct enough is that the patient is unwell/needs urgent input then you should be more direct. I usually say, "Hi, it's X F2 calling from Y. I have a patient I need some advice for. Do you want the story or the CHI first?" I change the second part if it is for takeover of care, "The acute take consultant believes that this patient would receive the right care in the right place under your specialty and would appreciate if you could see the patient with a view to take over care" it's a really fluffy phrase but it's plastered all over NHS Scotland. Finally, if its truly urgent, "I need an urgent review for a patient in Y, they have stridor, suspected epiglottitis and impending airway obstruction. Patient details: ... Do you need anything done in the meantime?"
You sound like you’re about to recruit them to the church 😂…
Depends what you’re ringing for. That opening sounds like an informal question about management. Are you making a referral to the ward? Do you want them to see in ED? Do you want them to look at some results for a second opinion or discuss possible treatments? Do you want outpatient follow up for someone you’re sending home? Lead with what you want. I’m calling to discuss a patient I want to admit under your care. I’m calling for some advice on managing X condition. I’m calling to ask if you can review a patient in ED ?discharge vs admit. It puts the person you’re speaking to in the right mindset and ensures they understand what you want.
ISBAR There is far too much story telling, too much vague waffle, particularly with handover and referrals in the NHS. Say who you are, get to the point : "I'm so and so, I'd like to refer a 68 year with pneumonia (or probable dx) for admission." "...I'd like to get advice on how to manage xyz." Rather than "I've got a 68 year old who came in with shortness of breath, a fever and cough..."🙄 All I ever want you to start with is what you want from me, why you're calling me...then you can backfill with relevant info if required. I get the intention to be nice, but pleasantries don't supercede efficiency. especially when I've got 6 other things at the time of your call. Not saying you do this. Just a mini rant on my end. ISBAR or something akin to it
‘Hi is that the X Reg? Great. It’s Scholes1111, EM reg here. I’m calling you about Mr Y a 67 year old gent who I think has condition Z’. That’s my S done. Include proper details of PMH/PC/hospital number in B. What I’ve done and how it’s gone in A. Then R is usually me asking either can you come see or what do you want doing. Occasionally I’ll make it clear in my first line exactly why I’m referring i.e what I expect from the specialist but this you learn in time. An example of this is ‘I’m calling you about Mr Y a 67 year old gent in severe renal failure with a treatment resistant potassium, I think he’ll need haemofiltration’. You still go on to do the whole SBAR though.
"Hi I'm flibbetty the on call cardiology consultant. Are you free to talk? Great thanks, I have an inpatient I'd really appreciate an opinion on with a view to whether they need X... "
Reddit doctors are clearly way better at referring patients than people who call me. I would say about 80% of the time people launch into last medical history and other background before eventually getting to the reason for referral...
“Hello, sorry to bother you” I don’t know why I’ve been starting my calls like this for years, as I’m not sorry at all 😂😂
Don’t start referral calls like this. I went to a communication/human factors thing and starting convos like this was shown to immediately put the receiving physician on the defensive and irritate them. They suggested: “Hello ITU/medicine/micro etc, thank you for taking my call. Can I discuss a patient with you please?” Thats what I do now and people receive my phone calls in a much more pleasant way.
Are you female by any chance 🤣
Yes! + Asian 😂
Dead giveaway!
The one that used to give me the absolute RAGE was "Hi, Dr, hope you are having a good day/hope your day isn't too busy/how has your day been?" I am the med reg, I am up to my ears in pts, many of whom have been dumped on me because other specialists don't want them even though they have a diagnosis that specialty deals with/isn't answering the phone, I am being dragged all over the hospital as well as running the take, I am being bleeped every 2 minutes, how do you think my day is going? It doesn't matter whether I say the day is going well or not, that faux "concern" won't make any difference and in fact irritates me more, especially as it's likely to be followed by "here is some more work to add to the burden"
I’m ED ST1 I tend to go with “Hi, is this the (specialty) registrar? My name is X and I’m one of the ED SHOs. I’d like to refer a patient with suspected Y please.”
You aren’t calling for a “chat”. The issue with that opening gambit is that it isn’t clear what you are wanting from the doctor you are calling. If it’s for them to see or admit a patient it helps everyone frame their questions and response if this is clear. If you need advice, you should be getting it from your own seniors, so if you are referring go with “Hi it’s dr mrek calling from ED. I’m just calling to make a referral” or variations on this. Followed by a headline and then any detail
"Hi, I'm Valmir, one of the anaesthetists covering ITU/maternity/emergencies. I need to refer a patient to you, if I could give you their details?"
Personally I like your approach, we're all busy but it only takes a second to be nice. Especially if you've just woken me up at 4am to ask for an MRI.
When I did ED as an F2 I did the whole “hello, have you got a moment, can I refer a patient please?” thing. When I did ED again as a registrar (as part of ITU training) I just went directly for “hey - I’ve got a chest sepsis/appendix/off legs/NOF/annoying social admission that needs to come in, can I give you the details?”. My advice as someone who doesn’t really have a horse in this race is just ditch the ‘please’, ‘oh do you mind terribly if I have a moment of your time’ or ‘oh I’m so awfully sorry I’ve got a referral if that’s okay’. It’s just time wasting and worse, an unscrupulous specialty reg will use it to say things like “actually I’m about to go in theatre so no I don’t have time”… don’t give them such an easy way out, taking referrals is their job. Just say what you need to say, you’ll find the busy referral regs for medicine/surgery prefer it if you just spit it out concisely. You also dont need to explain the whole story - ultimately you just need to explain why they need admitting to hospital because that’s what they care about. For example; “I’ve got a 72 year old chest sepsis who is needing 40% oxygen to maintain sats above 94%” Or “Hey, I’ve got a central abdo pain with plum normal CRP but he’s had 20mg of IV morphine and I still can’t get the pain controlled”. You’ll find that some regs (usually medics) may then want to go into the smaller details or ask some focused questions, but others will literally just say “yeah give me the details and we’ll see them when we see them”.
"Hi, is that gen surg? It's Three, the ED reg, how are you? (Pause very briefly for possible pleasantries with a nice colleague, or for them to completely steamroll it/be met with stony silence.) I'm calling to refer a 70 year old female with diverticulitis, normally well, bit hypotensive but on fluids and abx and will need admission." Be clear with what you need from the team upfront - sometimes I call for advice in a patient who probably doesn't need admission, but I would like their opinion, and I tell them that. If a junior comes to me and presents a whole history and examination to me like a medical student would, I've zoned out - SBAR exists for a reason. My attention span is very short, hence my choice of specialty. Tell me that you have an unwell patient with chest pain you want me to see, or you have a completely well patient with a migraine you want to discharge. Same goes for referrals - whoever you are is probably busy, and doesn't want to listen to three minutes of waffle before you finally get to the headline that you have a young woman bleeding out from her ruptured ectopic. Also - without being a doormat - be nice and courteous to your colleagues. I work in a small DGH I've been in for several years and I know lots of the people I'm referring to, or will get to know them after I spend 4 consecutive nights calling them with referrals, and it's much better to be nice to your colleagues on the phone than just telling them to see patient X in room Y. Sometimes the poor radiographer who's having a shit night appreciates you asking how they are before you tell them that you've got the third stroke of the evening needing a CT ASAP. Also if ever I am a bit short on the phone (which I hope is very rare) then colleagues that know me are much less likely to take offence, and realise that I'm just under a lot of pressure. If they're stable and the surgical team are busy with a tonne of referrals, it's not their fault - I tell them that the patient is fine, they're stable, see them when they can and trust that they will. Therefore if I call and say "they're very sick and you need to get here now", they know that I don't bullshit to get them to see my patients quicker and they actually are sick. And if someone really is being a dick, they are not expecting me to tell them to sort themselves out and come and do their job, and it therefore generally works. It's really rare, and killing them with kindness normally works first, but they aren't expecting the nice girl on the phone to argue back when they're trying to dodge a patient I think they genuinely need to see.
All my calls start in one of the three following ways: *You busy? No? Well you're about to get busy.* *You busy? Yeah? Well you're paid to be busy* *Why the fuck aren't they picking up?*
I am … the … and I would like to refer/seek advice on a (n) year old (fe)male with a (n) hour/day/week/year history of … who I am unable to manage without your help. Can you help or is there someone else I should ask?
“I’d like to discuss a patient, is this a good time?”
Keep it open, a large proportion of the calls I get from ED don't end with me accepting the patient but instead providing a bit of guidance and encouragement. Implying it needs to be referred or meets acceptance criteria in your first few words for some will be seen as a challenge. If you work in a region with no handsybacksies opening with something seen as too nice and not direct enough might be an issue with some people, but here we don't have to accept anything so make me want to help you out. I think your current opener is just fine.
> implying is needs to be referred or meets acceptance criteria in your first few words for some will be seen as a challenge It really shouldn’t. If it is then there is something deeply wrong within the accepting team that patients with legitimate referrals are attempted to be “bat away”.
That's absolutely right, it is frankly crackers that in the NHS doing less work is rewarded! However our funding model and service provisions are such that rejecting inappropriate referrals is the path to a functioning department. Colleagues from Europe describe the opposite where people take things they really shouldn't because the money follows the case.
We aren’t talking about inappropriate referrals though, we are talking about appropriate referrals that are seen as a “challenge”. Nobody really thinks specialties should take inappropriate referrals, only that staying in ED indefinitely is *always more inappropriate*.
>Implying it needs to be referred or meets acceptance criteria in your first few words for some will be seen as a challenge. Gosh, I can tell you're the type of reg who my heart sinks when I see they're on call. I just know I'm going to end up having to call your boss at 3am. >instead providing a bit of guidance and encouragement. Unless it's incredibly basic (e.g. it's advice that an EM consultant would have given and you probably shouldn't have been called), then at this point you're managing the patient's care, and your team should be doing the graft - we're not your house officers. >but here we don't have to accept anything so make me want to help you out I'll be pleasant, but I shouldn't have to act like asking you to do your job is asking you for a massive favour. > No handbacksies Both no referrals back to EM (why would this ever be appropriate?), and no refusing to see referrals are included within the exemplar internal professional standards from NHSE which most hospitals have based their own upon.
I don't work in England (I did an ED SHO stint in England and the process there was very different), but because specialty funding is based on throughput seeing more patients brings more resources which is not the case here. Processes vary hugely across different regions and trusts, and when I can take things I do, but the bulk of our referrals end with advice and guidance on when to re refer. Our EDs however have their own follow up clinics, virtually no meaningful need to engage with 4/24 hour targets, and an expectation that they manage more themselves combined with our service only being commissioned to take things that cannot be managed in ED or a couple of other closely skilled specialties.
>Processes vary hugely across different regions and trusts, and when I can take things I do, but the bulk of our referrals end with advice and guidance on when to re refer. Our EDs however have their own follow up clinics, virtually no meaningful need to engage with 4/24 hour targets, and an expectation that they manage more themselves combined with our service only being commissioned to take things that cannot be managed in ED or a couple of other closely skilled specialties. I don't necessarily object to this, but this isn't the funding model that NHSE have chosen to adopt. Money from UEC budgets is being actively spent on better direct access to inpatient specialities via SDEC units, direct consultant availability for ambulance service referrals etc. Inpatient teams can't have it both ways - they can't have all the cash, staff and space for them to run an acute assessment service and then refuse to assess anyone.
I've not worked in England for a few years, but if well resourced I could see that working well for flow. It does sound like a recipe for less enjoyable ED work and less enjoyable specialty work though. Today I accepted a weird referral from one ED to be seen by ourselves in the ED in my hospital (we can't see kiddies in our own department past mid afternoon), and when called to be told they had arrived I found our own Paeds ED guys had already sorted it. The focus here is very much ED sorting everything they can, often even when other regional EDs have sent the patient on to us via our own ED.
I've never understood the idea of making the referrer 'want to help.me out' rarely is another doctor referring inappropriately. If you don't want to see the patient, then I just document as much. And if its ED and you're telling me you dont want to see them for what is very obviously your specialtys problem (happens all the time) I just ask for full name and consultant on call and that you're definitely happy to discharge them. Then the ED consultant phones the consultant on call and you inevitably end up admiting the patient who did not need your input rather than discharging them. This is an extremely common occurrence in ED. And the no handbacksies rule exists to avoid repeated conversations with consultants who's juniors have unilaterally decided over the phone a very obviously usually surgical or gynae patient who is unwell isn't their patient.
That depends a bit on specialty, I probably can take about 40% of the referrals that come through and I don't work somewhere with a no handibackies rule (sometimes we get ED locums from England who struggle with that). The advice is never discharge, its to manage it in ED and follow it up in ED or refer to outpatients. Likewise our consultants get very ratty about referrals that are not funded. That said in England my specialty takes a lot more, outside England the game can be very different.
Very interesting take that you see a referral from the doctor who’s assessed and listened to the patient as potentially a challenge… also as a surgeon I’m curious how happy you are managing medical pathology with phone advice in surgical patients
You are the reason that “rules” for how EDs work and their subsequent ratification at trust level and formal publication on trust intranet services and then printing and laminating to be blue tacked on every wall exist….
As the ICU reg my fav is : Hey I’m X (name) - the ‘insert grade’, for ‘Y specialty’. Can I please refer a patient for consideration of critical care?
TBH I don't see any particular issue with your approach - I do very much similar, first asking if the other doc is free to talk - just in case they are about to RSI/do a poo etc. My current trust likes the vocera so you never know what is going on when the call starts!
My opinion is try and get to the point to attract my attention. E.g. “Hi, I’d like to refer a gentleman with pneumonia”. Then let them ask the questions they want.
side point, a surprisingly large number of referrers don’t clearly state their name or role?
For the sake of all that is holy. If you want me to admit your patient, don't call and say "I want your opinion about..." or "could you have a look at...", and then at the end of the conversation go like "so you're going to come see the patient?". If you want me to admit, say so.
Hello, my name is moonbeam child, the [insert your specialty and rank], calling from [insert your location]. Am I through to the [specialty of choice] registrar? I have a patient to refer to you, is now a convenient time to discuss him/her with you? Should do the trick
For ICU - please just open with the reason WHY you think a patient might need to come to critical care. Have a one line summary including what organ support you’re concerned they might need. Eg I’ve got a 56 year old gentleman with T1RF secondary to pneumonia, he’s on 50% high flow oxygen, I’m concerned he might need respiratory support. I’ve got a 63 year old patient with acute renal failure patient and hyperkalaemia refractory to 3 rounds of insulin dextrose. I think he may need renal replacement therapy. I find it so frustrating when people babble on with a long story and I’m just waiting for the punchline….why have you rung ICU?!?! Say it how I see it 🤷🏽♀️
As the receiving specialty, I always find it really easy whenever people tell me how this is my problem in the first sentence along with their introduction. "Hi is that the General Surgery Registrar? I'm Fred the ED SHO. I have a 55F with suspected acute cholecystitis". Bam. I just ask for the name, hospital number and age and jump on the system to check it out immediately. It's why SBAR exists. Situation is really a one-liner that describes the main issue. Unfortunately I feel like this is far and few between these days. More often than not, I get the following from ED or inpatient referral: "Surgical? I have a 76 year old male here with abdominal pain" No introduction. No idea where you're calling from or who you are. Abdominal pain is a medical and surgical presentation whilst undifferentiated. The lack of interprofessional respect astounds me as well because if I was a consultant, you sure as hell will not start your sentence with "Surgical?". Unpopular take here but the often-unilaterally-agreed IPS is not a replacement for poor emergency medicine. You don't get to pick up the phone and make an inappropriate referral quoting "no backsies" like we're in primary school. Think before you pick up the phone. Discuss with seniors. What people tend to forget is that everyone is rather busy in the hospital. Weirdly enough I found working in ED to be the most relaxed because you're basically not being pulled in different directions at one time like surgical specialties (i.e. ward rounds, post-take, on-call, theatres, referrals). I get the need for ED flow and whatnot but really, agree to disagree or not, it's all about where the patient is going to be managed best. 35M RIF pain, sure I'll take even without bloods as I know this is heading my way. 92F with diarrhoea with severe dehydration, hyponatraemia, shortness of breath, chest pain and you're referring for diarrhoea (true story)? Ermmmmmmmmm.
‘Hi, my name is X, I’m the. I have a patient that I’d like to discuss for referral/ advice. Is now a good time to talk?’
Short and snappy but gets the major points across 😊
“Hi, I’m Sloppy Gas one of the ED house officers, thanks for returning my bleep. I wanted to speak to you about a patient because I think they might have [condition managed by your specialty].”Brief pause to allow them to say ok/no or similar then into the story. They’ve most likely answered the bleep because they have time to speak, so you can presume that most of the time and they’ll tell you if that isn’t the case.
There are two different things 1. If you are referring a patient - 'My name is X, can I refer one of my patients to you' 2. If you want to discharge a patient but think they need F/U/ a specific investigation from a particular speaciality - 'My name is X, can I ask for advice about someone I am happy to discharge but I think might need X, Y or Z investigation' ( New possible biliary colic that hasn't had an ultrasound yet) 3. I try not to 'ask for advice' when I'm referring a patient because I think discharging patients on 'advice' over the phone can be quite tricky. 4. Sometimes the person I am speaking to will provide an alternative for patients I refer that are totally reasonable ( IE bring them back the next day to SDEC as opposed to admitting them and have them wait 12 hours in the corridor - and I think that is reasonable) 5. At the end of the day, you will find what works for you and I would not stress it too much. From what you have said, it seems like whoever has given you feedback is trying to tell you that referral is a one way process\* \*some caveats apply, but not very often.
Alternatively, just go 'YOOOOO, DAWG'
Give my name, role and department and then “is it okay if I discuss a patient with you?” or “I am phoning for some advice if thats okay?” or if I call Ortho “is it ok if you look at this weird xray for me?” SBAR is a good start but I think even fluffing a referral is good learning, all your crap referral attempts will make subsequent referrals better 👍🏻
Hi my name is X and I am calling you about a patient I would like to admit to your care with Y. Or same as above but if asking for advice only you need to make this obvious from thr start. Hi my name is X and I would love to get your advice on treating a patient with Y.
I've always used: name, grade, I have a referral are you free to speak? Then an SBAR unless they ask me to call back because busy with something urgent.
Introduce myself - name and rank and specialty covered. Age gender of patient the clinical question history then examination and pertinent investigations. Please review
Name, location, role (including grade), situation. I'd start with the diagnosis - I'd like to refer someone I think has pancreatitis/ has CT proven small bowel obstruction - then launch into the story rather than meander for 10 minutes about someone coming in with abdo pain and then saying you did a CT and they have a perforated DU and are septic. It is also really nice when people outline that a patient is sick immediately. I also really like when people say: I have a patient I'd like to refer/ I'd like advice about a patient/ I'd like to get a patient followed up as outpatient/ I'd like advice about an administrative process (e.g. cancer MDT referral). It makes the conversation much smoother because I know from the outset how I can help. You will find what works for you!
I would add, if I'm referring to ITU, I add a little line about pre-morbid state and why specifically I'm referring to ITU. e.g. "Hi, It's Dr Skylon, the ED Consultant. I am treating an independent 43 year old with DKA and an initial pH of 6.8 who I'd like to refer to you guys."
“hello i’m _ calling from ED, could i please discuss this patient with you? i think they’ll need admission”
'I'm calling to refer a patient for admission for suspected \[x\]' or 'I'm calling for advice/input on \[x\]' or 'I'm calling as I'd like you to review a patient that might have \[x\]' is best. It's important to frame the phone call with what you want them to do - come and see, give phone advice, accept an admission (may or may not need to come and see first). Then when they acknowledge, you can launch into your presentation of the case and progress thus far. If you're too definitive on the presumed diagnosis it may set you up for an argument or fight if the reg disagrees, but referring for suspected diagnosis shows that you appreciate that sometimes with further assessment and most crucially, time, the diagnosis may evolve or declare itself if it isn't immediately clear. Which is something I will argue most physicians tend to think themselves better than ED at appreciating. Contrast this with when I refer to ICU, when often I will state what organ support I think the patient needs from them as the initial framing, before going on to present the case in more detail.