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Gastroenterology (B32)

General Medicine / Gastroenterology (B32)

Welcome to B32

32 bed gastroenterology and general medical ward based on the 3rd floor of the B block. The ward predominantly cares for patients with inflammatory bowel disease, non-surgical upper GI and liver disease.

Key Contacts

  • SCN – Betsy Symon
  • Clinical Lead – Stuart Paterson

Day to Day

  • Normally the ward is divided into 2 teams who are each responsible for half the ward (beds 1-16/ 17-32). Each team consists of a ‘senior’ and ‘junior’ doctor.
  • There is a physician of the week (on- call consultant) who will be responsible for all the new patients that come up to the ward regardless who they have been admitted under. He/she will conduct a daily ward review where they will review all new patients and any others that were previously under them.
  • Individual consultants retain responsibility for their own patients (unless they are on leave) so enquiries about the patient should be directed to the consultant in charge.
  • In general consultants will typically see their patients twice per week. Timings of ward rounds often vary due to other commitments.
  • If the patient is not being seen by a consultant it is the ‘senior’s’ job to review the patient on a daily basis (as FY1s we are encouraged to review patients daily and discuss them with our senior to encourage learning).
  • There is a ward handover with nursing staff first thing in the morning; thereafter middle grade doctors will start a ward round, each accompanied by an FY1 if staffing allows.
  • After the ward round jobs are divided amongst the team including: phlebotomy hand backs (remember to check the box at 11am), referrals, medication changes, family updates, discharge letters etc.
  • Afternoons are generally spent chasing and acting on results, updating patients/families, attending clinic/endoscopy and preparing discharges for the following day – B32 can get really busy so it is sensible to try to do some advance prep work if possible.
  • The FY1 will go to handover at 16.30 in cardiology seminar room to handover any jobs or sick patients to the oncall team

Typical Staffing

Usually the ward will be covered by 2-3 FY1s and 2 middle grade doctors, with consultant ward rounds most days. On days where staffing is better there are usually opportunities for attendance at MDT meetings, clinic or endoscopy.

Consultants (9) – Dr Watts (Clinical Director Medicine), Dr Paterson (Clinical Lead Gastroenterology), Dr Burnham, Dr Heron, Dr Salunke, Dr Ahmed, Dr Morrison, Dr Clark, Dr Leithead

Responsibilities

FY1

  • Responsible for ensuring full clerk-in is completed for patients admitted directly to B32 (REPAT’s, admissions from home etc)
  • Complete any referrals, bloods, cannulas, other jobs required by seniors
  • Put patients out for bloods on ordercomms for the following day
  • Essential to check order comms ‘phlebotomy printing’ section daily to complete any bloods that the phlebs were unable to do
  • Handover to colleagues at 1630 daily meeting
  • Review sick patients with senior support

Middle grade

  • Carry out ward round and liaise with consultant regarding management of patients
  • Work with AHP/nursing/junior medical staff to plan patient care and discharges
  • Review sick patients
  • Complex family discussions and referrals
  • Support junior colleagues with ward work or concerns/queries
  • Attend clinic as per weekly rota and as ward work allows
  • Attend endoscopy sessions (dependant upon grade/interest)
  • Insertion of ascitic drains/supervision of juniors learning to do LVP

Education

Monday 12:30pm – Medical Division Meeting/ Grand Round. Lunch will be provided. Lecture Theatre. Medical Education Centre, Level 3

Wednesday 2.30pm – GI Unit Meeting. Junior medical staff will be asked to prepare interesting case presentations and disease reviews on a rotational basis. Lunch will be provided. Clinical Offices, Level 2

Last Wednesday of each month 3pm – Morbidity and Mortality meeting. This should be prepared with the M and M slides in the B32 folder of the V drive. Any patient that dies on the ward requires discussion. Clinical Offices, Level 2

Medical Division Meeting / Grand Round is weekly via MS Teams at 12.30pm and is advertised under Events.

FY1 & FY2 Teaching is weekly on a Wednesday and Thursday via MS Teams at 12pm and is advertised under Events

Useful Info

  • Outpatient Investigations: It is VITAL that any planned outpatient investigations are requested prior to discharge and that this is documented clearly in the case notes/ immediate discharge summary.
  • Outpatient/ Clinic Follow-up: Any follow-up arrangement should be clearly documented and where appropriate the discharge letter should be copied to relevant health professionals who will be involved in the patient’s subsequent care. There is a follow up chart on the wall in the MDT room.
  • Endoscopies are performed daily Monday to Friday in the Endoscopy Unit on level 1. Endoscopies are requested using the relevant Upper GI endoscopy and Colonoscopy/ Flexible Sigmoidoscopy request forms (found in paper copy on the ward). Please complete the forms fully providing all requested information and a summary of the reason for the request.
  • Colonoscopy bowel preparation is usually given as Moviprep. For a morning colonoscopy two sachets of Moviprep should be prescribed. The first jug (sachet) should be started at approximately 1pm on the day prior to the procedure, with the second jug started at 6pm.
  • ERCP lists take place in the endoscopy unit on Monday (Dr Burnham), Wednesday (Mr Crumley) and Friday (Dr Heron). Requests should be submitted via the standard ERCP request form (available on the intranet) following direction from the GI consultant requesting the test. The request should detail the patient’s history, relevant imaging (US/ CT/ MRCP) and blood test results (including LFTs, FBC and coagulation). Make sure a coag level is done the day prior to the patient going for ERCP and the patient’s PT <18. If >18 will require Vit K and coag rechecked 6 hours later.
  • The team who have looked after the patient during life should issue the Death Certificate; after discussion with the patient’s consultant about cause of death, this certificate should normally be handed to the relatives in person 9.00am – 5.00pm Monday to Friday. If a death occurs out with these times the Death Certificate should not be issued until a member of the patients team is available to discuss the death, unless under exceptional circumstances. The General Practitioner and the patients Consultant MUST be informed of the death as soon as possible. The call to the patient’s GP should also be documented in the case notes.