NHS Borders education
Borders General Hospital Medical Induction Booklet 2024
1. Introduction
Hello and welcome to General Medicine at the BGH - we hope you will have a great 4 months here!
This induction booklet has been created by previous junior doctors to hopefully make the transition to BGH slightly smoother and to use as a quick reference guide during your first few weeks in the job.
2. Getting here
The BGH is 40 miles south of Edinburgh. There are 2 options for commuting to BGH:
- Driving
- A68 or A7. Both take around 1 hour but A68 is probably a bit quicker and a better road.
- Parking is free
- Train
- There is a direct train from Edinburgh Waverly to Tweedbank station which takes just under 1 hour. Tweedbank train station is then around a 20-minute walk or 5–10-minute cycle to BGH.
3. Medirota - soon to be replaced with Optima
Medirota is an app used for the BGH medical rota. You will be provided with a login prior to arrival at BGH.
This allows you to view your rota for the coming weeks, as well as the rotas for all other medical team members.
You can request annual leave via the app (Menu->Request leave->input request). You can also see how much leave you have left for the post (Menu->Summary).
If there are any changes to your rota you will receive an alert via the app.
If you are unable to attend work due to sickness or other reasons, please phone hospital management at 8am and state your name, grade, area you are covering, any on call and how many days you are likely to be off. If it is a weekend please phone the on call consultant via switchboard and also send a message on medirota.
4. FY1 Shifts and Daily Routine
|
Allocation |
Start Time/ |
Finish/ |
Handover To... |
Role |
Escalation |
|
Handover |
0800 The Tryst |
0900 (handover to ward teams)
1600 |
FY1s on;
W4 W5 W14 Borderview BSU MKU
At 0900
|
Handover from H@N for W4/5/12/14/BSU/MKU
Collect 6644 from the Tryst
Complete any tasks needing performed urgently prior to 0900hrs.
At 0900hrs, hand over the bleep to the “HOP” FY1 and disseminate any handover to the relevant wards. (It may be helpful to be based in the Mess). Then go to your assigned ward.
|
1. H@N SpR (6006) |
|
Ward Late |
0900 on base ward.
Start late cover 1630 |
2100-2130 Tryst |
H@N team 2100hrs Tryst |
Work on daytime ward until ~16:30
Pick up bleep 6644 from HOP FY1
Take handover from Ward teams for; W4/14/BSU/MKU and complete jobs/ reviews
Leave 6644 in Tryst at 2100 |
1. Long Day Middle Grade (6621) 2. Take SpR (6006) 3.On-call consultant (switch) |
|
MAU Long Day |
0900 Ambulatory Care |
2100-2130 The Tryst
|
H@N 2100hrs Tryst |
Attend Cardiac Arrest Team Huddle at 0900hrs. Collect bleep 6004. Then go to MAU to join consultant ward round or start jobs.
1100: morning huddle You will be expected to update floorplans and create jobs list.
1500: afternoon huddle. Discuss deteriorating or dying patients/update on discharges. |
After 1700hrs: 1. Long Day Middle Grade (6621) 2. Take SpR (6006) 3. On-call consultant (switch) |
|
MAU Normal Day |
0900 MAU |
1700 |
MAU Long Day FY1 |
Arrive in MAU doctor’s office 09:00 and join WR (MAU handover starts 08:30). MAU role as above |
1. Middle Grade or Post-take SpR (7006) 2. Frailty (7019) or Acute Med Consultants |
|
Ward 5 |
0900 |
1700 |
Middle Grade on “Ward Long Day” |
Take handover for ward 5. Huddle at 09:00
|
1. W5 consultants (medical or cardiology) |
|
Ward 4 |
0900 |
1700 |
Ward Late FY1 (bleep 6644) |
Attends W4 for morning huddle at 0900hrs
Post-WR meeting at 1200hrs |
1. Senior junior doctor within W4 2. W4 consultant as per Trak |
|
Ward 14 |
0900 |
1700 |
Ward Late FY1 (bleep 6644)
|
Attend W14 at 0900hrs for morning huddle
MDT Tuesday morning 0900-1100 |
1. Senior junior doctor within W14 2. W14 consultant as per Trak |
|
BSU |
0900 |
1700 |
Ward Late FY1 (6644)
|
Attend BSU for morning huddle. |
1. Stroke Consultant 2. Post-Take SpR (7006) |
|
"HOP”, Margaret Kerr Unit
|
0900 |
1700 |
Ward Late FY1 (6644)
|
Attend MKU at 0900hrs
Work on MKU forms bulk of your day.
|
1. Palliative Care Team for PC patients. Medicalboarders: i) Boarders doctor (6014) ii) W4 consultant (switch) if no Boarders doctor |
5. Evening Routine: All grades
|
Allocation |
Cover/Takes handover from... |
Handover to... |
|
Ward Late FY1 (6644) |
W4/14/BSU/MKU |
H@N |
|
MAU Long day FY1 (6004) |
MAU |
|
|
Ward Late Middle Grade (6621) |
Ward 5 Senior Support forWards/MAU Reviews in Borderview |
|
|
Take Middle Grade (6005) |
Acute Med Reg TCI List Admits patients in ED/MAU |
|
|
Back Shift Middle Grade |
||
|
Take SpR (6006) |
|
EVENING COVER ESCALATION |
|
|
Area |
Chain of escalation |
|
MAU, Ward 4/5/14/ BSU/MKU |
1st: Ward late FY1 (6644) |
|
Take |
1st: Take Reg (6006) |
6. Weekend Day Routine (All Grades)
Handover: All Members of Staff at 0900hrs in The Tryst
Ward Weekday Teams should email all requests for weekend reviews to: Hospitalat.Weekend@borders.scot.nhs.uk
|
Grade |
Shift |
Contact |
Time/Role(s) |
Escalates to... |
|
Consultant |
Take Consultant |
*switch |
Review patients in Ward 5 and MAU in the morning and admits Take Patients |
|
|
Post-Take consultant |
*Switch |
Post-take previous day’s Take Patients |
||
|
Registrar |
Take registrar |
Bleep 6006 |
0900-2130hrs Admits Take patients in A+E Usually helps with MAU reviews in morning |
On-call consultant (*switch) |
|
Short Day Registrar |
Bleep 7006 |
0900-1700hrs MAU reviews and ward reviews if needed |
||
|
Middle Grade |
Take Middle-Grade |
Bleep 6005 |
0900-2130hrs Admits Take patients in A+E. Usually helps with MAU reviews in morning |
1. Take SpR (6006) 2. On-call consultant |
|
Long Day middle Grade |
Bleep 6621 |
0900-2130hrs Ward 5 Long Day Usually goes round W5 with Take/Post-take consultant then does jobs |
1. Short Day Spr (7006) until 1700 2. Take SpR (6006) after 1700 3. On-call Consultant |
|
|
Short Day Middle Grade |
Bleep |
0900-1700hrs W4 Weekend jobs. Handover from Weekend Handover e-mail |
1. Short Day SpR (7006) 2. On-call consultant |
|
|
FY1 |
MAU Long Day |
Bleep 6004 |
0900-2130hrs Goes to MAU and helps with either ward jobs, IDLs or reviews. Is on MAU all day. Handover from Weekend Handover e-mail |
1. Short Day SpR (7006) 2. Take SpR (6006) after 1700 3. Consultant |
|
Long Day Ward |
Bleep 6644 |
0900-2130hrs Looks after W12, W14, MKU and BSU. Handover from Weekend Handover e-mail |
1. Short Day SpR (7006) until 1700 2. Take SpR after 1700 3. Consultant |
7. Hospital At Night
Night-time Handover: 2100hrs in The Tryst.
Doctors covering the wards on the late shift give a verbal handover of any outstanding jobs needing done overnight, any unwell patients requiring review or ‘to be aware of’. Once you have handed over, you can leave.
The medical take team will also handover any new admissions from that day.
The Team:
|
Grade |
Bleep |
Role(s) |
|
ANP (co-ordinator) |
6344 |
Takes calls from all wards about jobs/unwell patients and distributes them amongst team |
|
ANP |
- |
Helps with ward cover and the medical take if needed |
|
Medical SPR |
6006 |
Admits Medical Take Patients and reviews unwell ward patients |
|
Middle Grade HAN |
6005 |
Takes Surgical and O+G referrals (Surgical and O&G SpRs are on site for advice/ support) Also covers theatre for C-section/Obstetric emergencies and will be shown how to scrub and where theatre is |
|
Middle Grade ED |
- |
Part of ED team overnight |
|
FY1 |
6004 |
Helps with ward cover and the medical take if needed |
8.How To....
i) Bleep
- Phone extensions are five digits, and all begin with 2_ _ _ _.
- Bleeps are four digits, usually beginning with a 6_ _ _.
- Dial 0 for switchboard
- Dial 9 prior to calling an outside line
Induction app has lots of useful numbers/bleeps!
To bleep:
Dial 58 -> dial their 4-digit bleep -> pause -> dial your 5-digit phone extension then # -> hang up when prompted
ii) Request bloods
To request bloods:
TRAK ->Select patient ->OCS ->New request ->Search for required blood tests.
If requesting bloods for following day: ensure you change the date and time prior to requesting bloods.
To collect specimen labels:
TRAK ->Select patient ->OCS ->Specimen collection ->Collect all required bloods.
All ABGs are processed in the lab, including those taken in ED. If sending an ABG to the lab – phone or bleep the lab to inform them that you are sending up a blood gas.
iii) Request a Porter
To send blood samples to the labs, you need to request for a porter online.
Intranet >Click drop down arrow on ‘Jump to an Application’ > Select Porter Request System > Click Login >Click OK >Click on the ‘+’ sign on top left side >Select ‘Other’ >Choose ‘Blood samples’ for Task subtype > Choose a start location from> Select Create
If the samples are urgent, click on urgent. (NOT in the case of cardiac arrest/medical emergency –a porter will attend as part of the crash team.
iv) Request scans
TRAK ->OCS ->New request ->Radiology ->Select relevant imaging-> Input clinical details and indication for imaging.
If requesting XR imaging out of hours or a portable CXR -> phone the on call radiographer to highlight.
If requesting CT imaging out of hours-> phone the on call radiologist to discuss and authorise. It may be appropriate to discuss this with a senior doctor first.
v) Write a Discharge Summary
Creating a discharge letter:
TRAK>click on patient>Clinical Summaries>New DL>Clinical Assessment>New
Templates:
There are some templates to use when writing discharge letters. Simply enter the relevant shortcut and press the spacebar to populate the discharge letter with headings to be filled in:
\MAU – for use in MAU/ward 5/ward 4
\dme – for use in DME
\strokeidl or \tiaidl – for use in BSU/for patients admitted with stroke or TIA
To add medications:
TRAK>click on patient>Clinical Summaries>New DL>Medications>New
It is important to perform a medicine reconciliation on discharge by comparing the patients discharge meds to their admission meds (can be found on their clerking booklet/on patient ECS). Please provide detail of any changes made to patient medications in the body of the discharge summary.
When the IDL is ready, got to DL Document Summaries tab > enter discharge date and click update. Do not authorise the letter if the IDL needs to go to pharmacy. Leave it as ‘In progress’. Please let the nurse looking after the patient know that the letter has been completed.
Do not ask GPs to chase results from investigations organised in hospital. These should be followed up by the Consultant.
vi) Write a Death Certificate
When a patient dies, the cause of death should be discussed with the patient’s named consultant (or a consultant involved in the patient’s care prior to their death).
If you complete a death certificate, please document it in detail in the notes. It is essential for any death certification to include:
- Date, time, location of death
- Time the death was officially verified by the doctor / nurse practitioner
- Causes of death listed on the certificate (1a… 1b… 2… etc.)
- Who was present at the time of death
- Details about pacemakers
- If it was required to be discussed with the procurator fiscal, and the outcome of this
- Details of any post-mortem
Once a death certificate is completed it should be scanned to your work email and emailed to the registrar office registrationservice@scotborders.gov.uk ; a copy can also be sent to the patient’s NOK if requested. Please inform the ward clerk once this is done who will post the original death certificate to the registrar office.
Deceased patients also require a deathcert IDL. This is done the same way as any other IDL but using the template \deathcert instead, and obviously, no need to fill up medications bit.
For specialist palliative care patients in MKU, the deathcertidl template is \mku.
vii) Access guidelines
Local NHS Borders guidelines can be accessed through the Right Decision Service app.
viii) Update patient floorplans & weekend handover
Floorplans are short summaries of patient care using the SBAR format. They are visible on Trak and as a result they move with the patient when transferring between wards.
Each patient in MAU should have their floorplan updated daily at the 11am huddle.
To generate a floorplan:
- TRAK-> Click on patient-> EPR-> Floorplan-> New -> Complete SBAR summary-> Update
Every patient on all wards should have an updated floorplan on Friday including plan for weekend review. The first line of the floorplan should indicate whether the patient requires a weekend review (e.g. WEEKEND 8-9th APRIL – WEEKEND REVIEW/NO ROUTINE WEEKEND REVIEW/SATURDAY REVIEW). Please indicate what specifically you would like the weekend team to review – e.g. review of bloods, fluid review, comfort review, general review.
Once completed, copy all weekend reviews for the ward in to an email and send to:
Hospitalat.Weekend@borders.scot.nhs.uk
x) Refer to Community Hospital
There are 4 community hospitals in NHS Borders, covering the 4 peripheral NHS Borders regions.
- Kelso Community Hospital
- The Knoll (Duns
- Hawick Community Hospital
- Hay Lodge (Peebles)
These aresuitable for medically stable patients with ongoing rehab needs or those receiving end of life care.They cannot provide IV therapy.
The Knoll and Kelso Community Hospital are managed by Consultant Geriatricians and ANPs. Referrals are made nurse to nurse.
Hawick Community Hospital and Haylodge are manged by GPs and patients must be referred and accepted. If you are asked to refer:
- Contact the GP practice for the community hospital and ask for the duty GP taking referrals for admissions.
- Once accepted, contact the discharge liaison team to let them know that the patient has been accepted and they will add to the list.
Patients being transferred to CH should have a Treatment Escalation Plan.
x) Hospital At Home
The Hospital at Home team is able to provide care for patients in their own homes. They can provide IV antibiotics (1-2x/day), IV fluids, IV diuretics, oxygen and supported discharge. They do not provide carers or physio so a patient must be able to function with existing POC or family support.
Patients are primarily elderly and living in the central Borders however patients can be discussed on a case by case basis and the team may be able to accept a patient depending on capacity.
If a patient is identified as suitable for HAH, refer via phone.
xi) Sign Off Your Results
It is important to sign off results on Trak. An “open book” indicates a new result. If you are happy with the results, tick the box to sign off. If you do not know how to action a result, please escalate this to a senior.
Those working in ED (mainly middle grades and registrars) may have outstanding results assigned to them. To sign off your results on Trak;
- Click ‘OCS’ from the top bar menu on Trak
- Click ‘Not Signed Results’
- You can then filter for you as the responsible clinician or requestor and sign off your unsigned results.
- Remember to change the date as defaults to the last 7 days only.
9. Referral Finder
|
Specialty |
Type of Referral |
Instructions |
|
Cardiology |
Paper
Phone (OOH) |
Hand in to Cardio secretary’s office outside ward 5. There are also the chest pain nurses (bleep 6550) who pick up many MAU ischaemic chest pain referrals each morning.
Urgent out-of-hours advice available via Lothian Switch and RIE Cardiology SpR |
|
Critical Care Outreach Team (CCOT)/ ITU/Anaesthetics |
Bleep |
CCOT bleep 6321 (0900-17.00hrs Mon-Sun)
Out of hours, bleep anaesthetics/ITU on bleep 3933 |
|
Dermatology |
E-mail +referral form |
dermatology@borders.scot.nhs.uk Referral form found on intranet and must be completed. Must be discussed with Consultant first. |
|
Diabetes and Endocrine |
|
|
|
DME |
|
|
|
ENT |
|
|
|
Gastroenterology |
|
bor.gastroenterology@borders.scot.nhs.uk |
|
General Surgery |
Bleep |
Gen Surgery SpR: Bleep 6008 |
|
Gynaecology |
Bleep |
Gynae SpR: Bleep 6017 |
|
Haematology |
Bleep |
Bleep 6233 (Haem CDF) or 6246 (Haem consultant) for advice in hours haematologyconsultants@borders.scot.nhs.uk |
|
Hospital At Home |
|
|
|
Microbiology |
Bleep |
Bleep 6231 for advice in-hours. Via switch for OOH. |
|
Neurology |
|
For urgent referrals or to discuss a case in person, contact the neurologist on call via BGH switchboard. Dr Connor (7021) and Dr Simpson (6563) are on-site at BGH and contactable by hospital bleep during working hours on Monday, Tuesday, Wednesday and Friday. On Thursdays Dr Connor and Dr Simpson are both in Edinburgh, and the consultant on call is available by mobile via switchboard. Discuss with own Cons or Reg before directly bleeping Neuro Cons. |
|
Neurosurgery |
Phone |
Via Lothian Switch |
|
Oncology |
Email or bleep to Acute Oncology Nurses |
Email: Acute.Oncology@borders.scot.nhs.uk Bleep: 3041 Out-of-hours Urgent advice via Lothian Switch |
|
Ophthalmology |
|
ophthalmology@borders.scot.nhs.uk
|
|
Orthopaedics |
Bleep |
Ortho SpR: Bleep 6009 |
|
Palliative Care |
|
|
|
Psychiatry – Liaison Psychiatry |
|
LiaisonPsychiatry.TeamReferrals@borders.scot.nhs.uk
|
|
Psychiatry – Urgent referrals/Crisis Team |
Phone |
Emergency/urgent assessment telephone 01896 827320 in-hours, admin staff will take required information. Out of hours - Borders Crisis Team, via Switch |
|
Psychiatry – Old age/MHOAT |
|
Mhoat.TeamSecretaries@borders.scot.nhs.uk |
|
Renal |
|
Email Jane Goddard and Wendy Metcalfe for advice in-hours (check with secretary who is covering). If urgent, out of hours advice needed, then call Renal SpR at RIE via switch |
|
Respiratory |
|
|
|
Rheumatology |
|
|
|
Stroke/TIA |
|
|
|
Urology |
|
|
|
Vascular Surgery |
Phone |
Via Lothian Switchboard |
When emailing a referral, please copy in the consultant who is responsible for the patient.
Find email addresses in the borders global address list in Outlook
10. Senior Support and escalation of unwell patients
In-hours: senior medical colleagues on your ward -> patient’s named consultant or ‘back door’ med reg (Bleep 7006).
Ward lates: middle grade covering ward 5 (bleep 6621) -> on-call med reg (bleep 6006).
HAN: middle grade (bleep 6005) -> med reg (bleep 6006)11. Treatment Escalation Planning
In the BGH, we use Treatment Escalation Plans to help guide decision making should patients deteriorate. These are orange forms available throughout the hospital. They can supplement a DNACPR or can exist alone.
Many patients admitted to hospital are frail or have complex multimorbidity and some treatments eg ITU care may not be appropriate. We aim to discuss escalation with all patients admitted to BGH but this must been done in a sensitive way, involving the patient and their family (where appropriate). They can also be updated throughout the admission should circumstances change.
12. Breaks
Canteen is located on 1st floor blue zone. Open 12-2pm for lunch; 5-7pm for dinner. Food can be eaten in canteen or taken away. Discounted staff prices for all food/drinks.
Doctor’s mess is located on 1st floor pink zone on the corridor heading towards the DME wards. It can be accessed via swipe card. A small fee will be deducted from your monthly pay (with your permission) to allow you access to the mess and use of the facilities/food supply. It is a very friendly and sociable place to enjoy some time off the wards.
RVS coffee shop located on ground floor by main entrance if you are in need of some caffeine.
13. Weekly Education and FY1 teaching
|
Monday |
DME Teaching 1-2pm |
DME MDT Room |
|
Tuesday |
Grand Round, 1-2pm |
The Tryst |
|
Wednesday |
In Situ Sim, Ambulatory Care (ad hoc) IMT and Registrar Teaching 1-2pm |
DME MDT Room |
|
Thursday |
FY1 Teaching, 2-3pm |
|
|
Friday |
Junior Doctor Forum (last Friday of each Month) |
The Tryst |
14. On-call accommodation
There is on-call accommodation available on site. Due to a current shortage of rooms, this is only available for those who are on a late shift and working the following day/those on night shift.
On-call rooms should be booked in advance by emailing bghaccommodation@borders.scot.nhs.uk You should receive an email confirmation of the booking.
Keys can be collected from administration office in hours and switchboard out of hours. Please ensure you return keys ASAP the next day to allow time for the room to be cleaned and ready for whoever needs the room that night.
Any issues with access to on-call accommodation should be escalated to Chief.Residents@borders.scot.nhs.uk
15. Useful Contacts
Rota Team:
Kirsten Graham, Clinical Services Manager (Bleep 6656, kirsten.austin@borders.scot.nhs.uk)
Megan Hume, Consultant Physician (megan.hume@nhs.scot)
*All rota requests via Medirota
Medical Education:
Kath Liddington, Peter Tennant, Debbie Dear medical.education@borders.scot.nhs.uk
Olive Herlihy (Director of Medical Education): olive.herlihy@borders.scot.nhs.uk
Accommodation:
Kirstine Black and Andrina Burgess: bghaccommodation@borders.scot.nhs.uk
HR, Travel Expenses and Rota Monitoring:
Victoria Roy: victoria.roy@nhs.scot
Chief Residents:
Chief.Residents@borders.scot.nhs.uk
Final words
We hope you have a great time during your time at BGH.
If you have found this handbook useful, please keep it updated so that it can be passed on to future junior doctors.
Good luck!
APPENDICES
Appendix 1: Hospital Layout
Ground Floor:
- The Tryst (labelled as “Chaplaincy”), location of Night, weekend and morning handover
- Ambulatory Care (labelled as “Day Hospital”), location of Morning Take Handover
- BSU – Borders Stroke Unit
- MKU – Margaret Kerr Unit (Hospice)
- Dialysis Unit
- BMC – Borders McMillan Centre (Cancer Day Centre)
- Emergency Dept.
- Endoscopy
- Radiology
- Staff changing facilities
First Floor:
- The Mess (opposite “clinical governance and quality”)
- Dining Room
- Ward 6/MAU – Medical Assessment Unit
- Ward 4 – General Medicine
- Ward 5 – Cardiology/Higher level Care (Level 1)
- Ward 14 – Department of Medicine of the Elderly (DME)
- Ward 12 – Border View (Interim Care)
Second Floor
- Ward 7 (General Surgery/ENT/Gynaecology)
- Ward 9 (Orthopaedics/Orthogeriatrics)
- Laboratory
- ITU
- Labour Suite/Obstetrics