When the list ends
What comes through on a surgical on-call?
On-call means new referrals as well as complications on the ward. The CT1's useful first move is to recognise risk, start treatment within competence and call the right person early.
The calls
Emergency department asks about acute abdomen, obstruction or sepsis; wards call about bleeding, reduced urine output, pain or a deteriorating postoperative patient. Theatre and recovery may need immediate review of a complication.
Prioritise and escalate
Use ABCDE for the unstable patient, ask for urgent senior and anaesthetic/critical care input where needed, organise access, monitoring, bloods and appropriate resuscitation. Do not leave another unwell patient unallocated: communicate who is reviewing whom and when.
Supervision and progression
Early CT1s assess and present with close registrar or consultant support. Responsibility for decisions and procedures grows with demonstrated capability; emergency operating and complex consent remain governed by competence, local policy and available senior help.
The handover
Name the patient, working diagnosis, physiology, treatment, pending results, clear review trigger and named owner. Unfinished jobs without an escalation trigger are a common avoidable safety gap.
Fictional surgical shift
Three calls, one trainee and a change in the plan
This illustration teaches workload management rather than a universal order for diagnoses. It assumes an early core trainee with a registrar available for escalation; actual cover arrangements must be checked at induction.
Start with enough information to allocate the work
Recovery reports a patient with new breathlessness and abnormal observations. ED has a referral with abdominal pain whose current observations have not yet been given. A ward wants a routine discharge prescription. The trainee goes to the deteriorating patient, asks ED for current observations and the immediate concern, and tells the ward the routine task will be delayed. The unknown referral needs triage information; 'abdominal pain' is not evidence that it is safe to wait.
Make the registrar aware of the competing risks
A useful request is: 'I am assessing the patient in recovery and need you here urgently. There is also an ED referral whose acuity is not yet established. Can you arrange another clinician to review that patient?' This explains why extra help is needed. It is stronger than asking the registrar to call back without describing the workload.
Change the allocation when the second call changes
ED now reports that its patient has collapsed. That patient needs an immediate emergency response from the team already there and surgical senior involvement. The trainee should not abandon the first unwell patient without a handover or assume they can personally cover both. They update the registrar about the simultaneous emergencies, confirm who is attending each location and use the hospital's urgent escalation route if help is not available.
Close the loop on the work that waited
When the acute work is allocated, the trainee checks the discharge request and any other deferred tasks. The patient may need an updated explanation of the delay; medicines may need review by another prescriber. A lower-priority task is still a responsibility. If the shift ends, pass on its current status and obtain acceptance rather than copying yesterday's job list.
Completed handover illustration
Hand over a decision, not just a pending result
Fictional example: a patient has been reviewed with the registrar, is currently stable, and has a pending investigation. The result and the clinical review both need owners.
A usable handover
'The registrar reviewed the patient with me after new postoperative pain. Observations are currently stable and the examination is documented. The requested investigation is pending. Dr Patel has accepted responsibility for reviewing the result and reassessing the patient this evening. Any deterioration needs immediate reassessment and surgical senior review, rather than waiting for the result. The patient knows we are still investigating the cause.'
Why this is more useful than 'chase the scan'
It gives the reason for the investigation, the current state, the agreed review and a named recipient. The deterioration contingency prevents a pending scan becoming a reason to defer clinical care. It does not prescribe a standard interval for every patient: the actual review time must be agreed from the findings and local plan.
Before accepting a rota, establish the support
Ask where the registrar is based, how to reach the consultant, what happens when the registrar is operating, and who covers competing referrals. Ask how an early trainee's supervised responsibilities are agreed and reviewed. The ISCP curriculum describes progression through levels of supervision; a CT1 title alone does not settle what someone can safely do overnight.
From understanding to practice
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