You are an SHO in a busy DGH and you have to prioritise the following:

A - A middle-aged lady is waiting, having been referred by her GP with ?PE. The nurse says she looks fine.

 

B - You get a call from a nurse on the ward who says that one of your patient wants to self-discharge.

 

C - Relatives of a recently deceased patient want to see you to discuss "things".

 

D - Your consultant is about to go home and wants to discuss tomorrow's rota with you.

 

E - You must finish your application form for a job. The deadline is for sending it is tomorrow

 

F - A GP is on the phone, wanting to talk to you about a drug query.

 

ANSWER (1 = first priority ; 6=last priority)

A (1) - The nurse says she looks fine but I can't be sure. Much will depend on how much I trust this particular nurse's judgement. I will quickly examine the patient and order some tests. Whilst the results are awaited, I can ask a colleague to keep an eye on the patient; I can then deal with other matters.

 

B (3) - I have no information about why the patient wants to self-discharge. He may be safe or he may not. I will need more information from the nurse. I will therefore make this patient a high priority. In order to gain the information, I may ask another SHO or a junior colleague to talk with her whilst I make sure that the ?PE patient is safe. If I have assessed quickly that the PE patient is safe I may take the call myself.

 

C (4) - The patient is already deceased so there is no clinical emergency but the relatives may be distressed and I will need to reassure them that we are thinking about their issue. They will not constitute a high priority because of the lack of clinical need but I will ensure that someone talks to them (e.g. a nurse) if only to apologise for the delay and reassure them that someone will see them soon. I would also want to gain more information about their reasons for wanting to see me so that I can be prepared when I do see them.

 

D (5) - Tomorrow's rota will not be as urgent as other more pressing clinical matters, but will be important nonetheless. I will apologise to the consultant for not being able to discuss straight away. I will tell the consultant that if he has gone by the time I have finished dealing with the patients, I will discuss it with him on the phone later on.

 

E (6) - I should have been more proactive in getting this done sooner rather than at the last minute. Therefore this will be the lowest priority.

 

F (2) - I do not know why the GP wants to talk to me and it may well be urgent. However a pharmacist (or a junior colleague) may be able to handle the query so I will pass the call to the pharmacist straight away. This will take a few seconds. Therefore giving it a high priority will not affect the safety of other patients.

 

Note that we could just as well have ordered it: F(1), A(2), B(3), C(4), D(5), E(6)
or F(1), A(2), B(3), C(5), D(4), E(6) or other similar combination. One thing is for sure: F,A and B will be top 3 priorities and C,D and E will be bottom 3 priorities.