*in addition to this handover document, please also contact the previous Williamstown orthopaedics HMO for handover.
Welcome to Williamstown Hospital as the orthopaedics HMO! The Williamstown role can be busy and time consuming, however it is also rewarding and there is a lot to learn. Williamstown primarily does a lot of elective orthopaedic operating and some simple trauma operating, so there is very high turnover of patients, and it is essential to remain organised.
Hospital Orientation
There is 1 surgical ward (Lower West Ward), which is also serviced by a urology HMO, general surgical intern and general surgical HMO. There is also the TCP (ground level) and GEM wards (level 1) covered by medical teams.
There is a doctors room on level 1 at the end of the row of offices. Passcode is 3016 (Williamstown postcode).
Admissions and theatre are on the ground floor to the right of radiology, as well as theatre change rooms.
Food/coffee is available across the courtyard at the hospital cafe, or a 5 minute walk from the hospital at Fifi’s by the beach.
There is parking in the doctors parking area next to the front entrance however there is also abundant free parking on side streets around the hospital.
Roster
| Mon | Tues | Weds | Thurs | Fri | Sat | Sun | |
|---|---|---|---|---|---|---|---|
| AM | 0730 WR + jobs (If able) SH paeds frac clinic | 0730 WR + jobs FH wound clinic | 0730 WR + jobs theatre | 0730 WR (If able) SH paeds frac clinic | WR + XRM/ Consultant clinic (in variable order) | WR surgical ward cover | WR surgical ward cover |
| PM | jobs /theatre | FH fracture clinic | rostered half day | jobs /theatre | jobs /theatre | OFF | OFF |
| After Hours Cover (5-8pm, x2 a week) |
Pagers/Phones:
- – there is no Williamstown pager
- – write your mobile number on the wall in the nurses station – this is how nursing staff/allied health contact you, and how switch will contact you if there is a MET call.
- – beware – reception at Williamstown can be patchy
Weekday Ward Rounds:
– be prepared with lists to start at 07:30 Monday-Thursday morning
– there may be a different registrar rounding with you each morning so it is important to know the patients and their plans really well
– for Friday morning, contact the registrar on Thursday and check whether the WR will be prior to xray meeting on Friday, or around noon prior to PM lists at Williamstown.
– If you are presenting xray meeting, specifically request the registrar for the ward round to be at noon as it is logistically difficult to complete a ward round and notes at Williamstown, and then be present to help set up and run through xray meeting at Footscray on time.
– The ward list is prepared on the audit (further information is available in HMO Induction 1st week)
– Often useful to print an extra list or two for the ward physiotherapists
Wards jobs:
– after the ward round is completed there may be ward jobs to do. This takes precedence over clinic attendance at other hospitals or theatre attendance. Once these are complete, you can attend to other duties.
– post operative joint cases are as per ERAS protocols
– if you are leaving Williamstown to go to clinics at other sites, you must complete any jobs prior to leaving as it is difficult to e.g. sign scripts/medical certificates or review patients remotely.
– ensure there is a surgical HMO present onsite for the period of time you will be away from Williamstown who is willing and able to cover any UCRs/ MET calls for orthopaedics patients.
– it is not part of the other surgical HMOs’ jobs to cover the orthopaedics HMO while they away – this is a favour. They are not required to complete jobs or discharges for the orthopaedics patients, so it is expected that anything the orthopaedics patients may need done is preempted and completed including scripts and having follow ups booked.
– the general surgical intern is NOT considered appropriate ward cover and you cannot leave if they are the only cover available as they are not allowed to cover specialty surgery. This has been reviewed with medical workforce in rotation 3 (2023)
– the ward nurses/allied health/pharmacist will contact you while you are at other sites if you have any questions, so it’s best to ask them prior to leaving if there is anything pending
Half-days:
– orthopaedics HMO halfday is usually on Wednesday PM. It is possible to swap PM half-days with other HMOs (usually only possible to do Monday/Thursday PM swaps). Please contact medical workforce to approve any swaps.
– hand over to the surgical HMO covering on this day
Weekends:
– covering all surgical patients
– often will cover weekends once every 3-4 weeks on Saturday and Sunday
– shift is 8am – noon
– after noon, hand over to the GEM/TCP resident covering for the weekend by calling through switch
– orthopaedics ward round may happen before or after your shift starts – contact Sunshine on call reg for the weekend to confirm time
– there may be patients from other surgical teams also on the ward. The registrar may round with you, or without you and contact you for jobs. If unsure, review the patients by 9 am and call the on call registrar from the respective units to check if they are happy with progress/happy for discharge
– usually the home team will prepare scripts (if not, the weekend cover must do the discharge scripts), however it is the home team HMO’s responsibility to book follow up for the patient if needed. It is good practice to let the home team HMO know that their patients were discharged when you see them the next Monday.
– weekend shifts can often be light on work – this is a good time to catch up on paperwork or pending discharge summaries
After Hours cover (weekday):
– the surgical HMOs take turns covering the surgical ward from 5-8pm on weekdays
– the orthopaedics HMO covers two evenings a week
– if there are any questions for other team’s patients, please call the home team registrar on call through switch
Day to night/ night to day handover:
– there is one HMO covering the whole hospital at night
– they will often meet you on the surgical ward for 8 pm / 07:30 am for handovers, however you can also contact them through switch
Unwell patients, MET calls and medical team support:
– standard UCR/MET call criteria apply to call a MET
– you will also receive a phone call through switch to inform you if there is a MET call.
– there is an ED registrar who will attend MET calls, however there is no medical registrar clinical lead present (occasionally a TCP/GEM registrar may attend however this is not a part of their role)
– there is a strong recommendation to be up to date with ALS before doing the Williamstown rotation for this reason
– for medical input (both during or outside of a MET call) you can contact the Footscray clinical lead medical registrar or specialty registrars at Footscray if needed
– patients may become unwell at Williamstown and need ongoing specialty team input and transfer out. A discussion with the on call registrar needs to occur with the home team detailing when the transfer needs to occur and to which hospital, the specific bed card, and whether this needs to happen via non urgent patient transport or ambulance
– for all transfers, the bed manager must be contacted (via switch)
– very occasionally there may be a patient that becomes extremely unwell and needs emergent transfer out or significant haemodynamic supports. In this case, regular ambulances may not take the patient and ARV will need to be called to transfer this patient out.
Transfers from FH/SH:
– patients are often transferred from FH/SH to Williamstown awaiting allied health clearance/other issues due to bed pressures
– OGS patients become orthopaedics patients at Williamstown – you are now responsible for implementing OGS recommendations and following them up
– as noted above, there is limited medical support – seek handover prior to the patient arriving and if there are any concerns that the patient is unwell or will require input that is not available at Williamstown, please raise these concerns with the on call registrar at the transferring hospital as soon as possible prior to transfer
Clinics:
– there are 2x SH paediatric fracture clinics (Monday and Thursday), FH wound clinic followed by FH adult fracture clinic on Tuesdays – you are expected to attend these after completing ward jobs if there is surgical HMO cover present
– it is expected that you stay till the end of clinics and help with DNAs/phone clinics unless you have been specifically asked to leave early (ward jobs should have already been completed prior to leaving Williamstown)
– there is also FH consultant clinic on Friday mornings – you are expected to attend this, however depending on what time the registrar rounds on Friday, you may need to leave around 11:30am or 12 noon.
– there is weekly consultant triaging to sort pre-clinic x-rays, on day x-rays, patient journey on day of clinic etc. this is a shared task with the FH and SH HMO group and is equally divided. You are expected to have this completed by the Friday the week before.
Theatre:
– there are many theatre opportunities at Williamstown if you would like to attend, however ward jobs and clinics are to be completed as a priority
– often you can attend theatre Monday and Thursday PM (once SH paeds fracture clinic is finished), on Wednesday, and on Friday PM (once consultant clinic/WR + ward jobs are done). The best way to manage your ward duties while in theatre is to complete jobs before attending theatre, and then between cases check with the ward to ensure there are no new jobs pending
– you may be asked to mark patients prior to lists starting – the patients may be sitting on the chairs in theatre or they may be sitting in the theatre admissions reception area
– please write your name on the board in theatre and inform the consultant, registrar and scrub nurse if you are going to be present.
Xray meeting:
– the Williamstown HMO is expected to participate in the xray meeting roster detailed on the HMO page.
– This is usually completed in un-rostered overtime which can be claimed, or if possible can also be done if there is a quiet after hours cover shift.
Radiology:
– radiology opens at 8 am and closes at 10 pm.
ED:
– ED is open from 8 am till 11pm.
Contributors and Authors
Updated by: Shyamolie Mathur – shyamolie.mathur@wh.org.au Date: 18/09/2023
(awaiting Orthopaedic Unit and MEU review)
Reviewed by: