Late colleague Flashcards
You are a CT1 and have covered a busy on call day shift. The night SHO is already 30 minutes late and you have 2 patients waiting to be reviewed in A&E.
How would you proceed?
Problem solving exercise - apply SPIES(R) framework
Seek inform
Patient safety
Initiative
Escalation
Support
Reflect
Seek information
* I need to fully assess the situation - is the colleague running late or completely absent? All the while also considering the clinical urgency of ward and A&E patients
Patient safety
* This situation needs rectifying imemdiately, as patient safety will be compromised if the shift is not covered. However, if I stay to cover the shift, my tiredness would also compromise patient safety.
Initiative
* I would try to contact my colleague as soon as possible and determine the delay or problem. If this fails, I would contact their flat mates or partner.
* In the meantime, I would make a list of jobs in order of urgency and manage any emergencies.
Escalation
* Update the registrar and/or consultant if not already aware to plan cover
* D/w site manager to see if the colleague contacted them, if any last minute cover or cross-cover may be available
Support
* It’s important to establish the reason why the colleague is late, maybe personal issues, maybe accident and require my support
Reflect on my own practice and how I could better manage such situations in the future
You eventually reach your colleague who informs you they are unwell and will not be able cover their shift. How would you proceed?
Patient safety is the priority number one - I would want to make sure that the shift is covered. Equally, if I stay too late, my tiredness would compromise patient safety.
I would update the reg, consultant on call and the site managers. It would be unsafe for me to cover this shift, but it is my duty to escalate to help arrange cover.
I would be proactive and contact other doctors who could potentially provide last minute cover. I would ask site managers to try and arrange last minute locum cover. Could someone provide cross-cover?
Most trusts have ‘step-down systems’, which may be necessary to do for the consultant on call.
I would also consider the well-being of my colleague and determine how unwell they were and if they require medical support
Is it ever acceptable to just leave the hospital in a situation such as this?
No, it is unethical to leave your on-call shift without arranging cover. It goes against our duties as a doctor (i.e. avoiding harm to patients - non-maleficence).
However, it is important to know my own limitations in terms of tiredness and over working, which is itself a risk to patient safety due to the impact on critical decision-making. Early escalation is of high importance.
Cover is arranged for the shift but another SHO tells you that this colleague has been late several times over the last few weeks. How would you proceed?
It sounds like this colleague may need some support with a medical, social, psychological or emotional issue, which is causing them to be late/absent for shifts. If these issues are not addressed, patient safety and the wellbeing of this colleague will be impacted.
I would try to meet the colleague in a private environment and tell them in a non-judgmental manner that you have noticed them being late on a number of occasions recently; and that you are understandably concerned. I would employ communication skills such as empathy and active listening to discuss any problems, which require support.
I would offer my support and suggest discussing issues with their educational supervisor or occupational health.
The colleague tells you they have had depression for a number of years but been very low recently due to a break up. Who would you suggest they contact for further support?
- Educational supervisor (if they feel comfortable)
- Occupational health
- GP
- Psychiatrist – if in regular contact
- Program director – if the trainee has explored all these avenues and may need to take some time away from training
