Making phone calls

Whenever you make a phone call to a hospital ward or a doctor who is on-call, make sure you are prepared before dialing. This will minimise any potential wastes of your time and the time of the person who you are calling.

If possible, make a note with the following seven headings. The first three form the introduction and the last four follow the SBAR communication system.

1. Who are you, what specialty, what grade? They must understand your level of expertise and responsibility before they can give you appropriate help.
• I'm the FY1 doctor in general surgery.
2. Who are you seeking? If you have called the wrong person, they will likely redirect you at this stage.
• I'm seeking the orthopaedic registrar.
3. Give them a one sentence summary of the situation. This will capture their attention for the rest of the call.
• I'm concerned that one of my patients is developing compartment syndrome. 
• Our consultant has asked me to request your advice about a patient.   

S: Describe the situation

• This patient is a 20 year old male. They presented 6 hours ago with polytrauma from an RTA. Headon collision at 40mph. Despite IV morphine they are complaining of extreme pain in the limb which is worse on gentle passive flexion.

B: Background

• 4 hours ago they had an internal fixation of a right femoral fracture. Past medical history includes asthma. No relevant past surgical history.

A: Assessment. Mention any medical scores.

• Patient is conscious and alert. Blood pressure 140/80. Heart rate 120bpm. Respiratory rate 20 bpm.  Gross touch sensation in the affected limb is reduced. The posterior tibial and dorsalis pedis pulses are weak but palpable. The NEWS value is 2.

R: Recommendation

• I was hoping you might review them as they could require compartment pressure measurement or fasciotomy.