How to triage your calls

Overnight, your most important skill isn’t any single clinical decision. It’s deciding, in the first minute of every call, how quickly you need to be there. Get that right and the rest of the night becomes manageable.

Sickest first

See the sickest patient first, not the first one who called or the one on the nearest ward. Every call goes into one of three groups:

• Now: go within minutes. The patient meets the calling criteria on the NEWS2 chart, the nurse is very worried, or something you hear worries you: new chest pain, a fall with a head injury, a low glucose with drowsiness.
• Soon: a new problem that needs a doctor, in a stable patient. Review within 30 to 60 minutes.
• When you can: routine tasks, such as rewriting a chart or prescribing a regular medicine. Batch these by ward.

In every case, tell the nurse when you’ll come and what to do in the meantime.

What to ask the nurse

Ask the same six questions on every call. It’s quicker, and you won’t forget one at 03:00.

1. Who is the patient, which ward and bed, and why are they in hospital?
2. What’s the problem, and when did it start?
3. What are the latest observations, and how do they compare with before? Ask for the NEWS2 score.
4. If they’re very unwell: what’s their resuscitation decision?
5. How worried are you?
6. Is there anything you’d like me to do now, before I get there?

Finish every call by telling the nurse when you’ll be there and what to do in the meantime, such as repeating the observations or checking a glucose.

Your list

Write every call on your list as it comes in, with the time, the ward and the bed. Tick it off when it’s done. At 03:00 you won’t remember who called first, and the list is also your handover in the morning.

An example: three calls at once

Phone triage card

Tick through it on your next call, or screenshot it.

• Write down the call, with the time
• Who, where, and why they’re in hospital?
• What’s the problem, and since when?
• Latest observations and the trend?
• Resuscitation decision, if they’re unwell?
• How worried is the nurse?
• Anything to do now?
• Decide: now, soon, or when you can
• Tell the nurse when you’ll come

If a call worries you, the next step is calling your registrar.