Registrar Job Description

  • Allocated to 1 half day/week – won’t always get it
  • Allocated to 1 full day off after doing a weekend on call (Monday after ward round for Footscray on call, Wednesday for Sunshine on call)
  • Generally Footscray weekend on call is busy and Sunshine is quieter
    • If Footscray has lots of cases and won’t get through outpatients, Sunshine registrar should organise to take a few cases to Sunshine/Joan Kirner to do (after running this by consultant on call at both campuses)
    • If not viable, then Sunshine registrar should also come to Footscray to assist in running a second theatre/double scrubbing where possible
    • Footscray registrar is still responsible for seeing their own campus referrals

Referrals

  • Western does not provide any adult/paed spine or hand (scaphoid only) advice except for rare circumstances where the patient is known to/managed by a specific consultant already
  • We also do not manage complex pelvic trauma = RMH
  • All Footscray referrals = Footscray registrar on call
  • All other referrals (Sunshine/Williamstown/external) = Sunshine registrar on call
  • Any referrals you take should be sorted before start of ward round next day (e.g. consent/mark/booked with theatre), unless unsure and still awaiting plan from consultant
    • Exception to this is if you’re required to be at a different campus early or offsite (e.g. St Vincent’s Werribee) and you have already handed over to next on call registrar

  • Other unit referrals accepted:
    • Almost all non-op fractures in elderly = AAC
    • Any wound without fracture and not close to major joint (even foot stuff a lot of the time) = plastics
    • Any foot wound/ulcer in a diabetic = vascular
    • Any major trauma = gen surg trauma call

Clinics

  • Clinics
    • If you are not rostered to a theatre list, you are expected to attend clinic (even if on call at separate campus and need to travel e.g. paeds fracture clinic at Sunshine while on call at Footscray)
      • Exception to this is the senior accredited registrars (unless there is no consultant in clinic or we are extremely short staffed and ask for help)
    • If you book a patient, you are responsible for ensuring:
      • Consent/elective admission form is done and put in pile to go to bookings or given directly to bookings
      • Patient is added to outstanding trauma drive with sufficient details including a phone number that is connected
      • The patient is discussed with clinic consultant and/or on call consultant
      • Patient is booked on emergency booking system (iPM)
      • Specific gear is ordered, or handed over to registrar doing the list or on for weekend to organise with consultant at more appropriate time
    • At the end of seeing physical patients the following needs to be completed:
      • Phone reviews (and giving outcomes to admin)
      • Referral triage (fracture and elective)
      • DNAs – residents will often do
    • If you do a case, it is your responsibility to correctly add it to audit and order post-op XR/bloods (or handover to reliable resident to organise)

Theatre

  • Theatre
    • Double scrub where able
    • If you do a case, it is your responsibility to correctly add it to audit and order post-op XR/bloods (or handover to reliable resident to organise)
  • Surgical bookings
  • ERAS

XR Meeting

  • → these are the general steps I go through in preparing the meeting:
  1. Look through the audit and cross reference this against iPM completed operations to ensure all operations are captured (and add any that aren’t)
  2. Look through the audit to ensure all information is correct:
    1. patient’s name/UR/DOB/gender
    2. admission consultant name matches the operating/assisting surgeon name (should be the consultant that has done the major operation or is calling the shots if there are multiple procedures)
    3. operation is correctly listed from drop down box and the date/side of the operation is correct
    4. there is a mechanism and operation documented in the specific box above the comments section
    5. preferably the implants are listed on the audit somewhere for elective cases (box or comments section)
  3. Make sure any complications are documented on audit
  4. From the reports —> post-op button in bottom right, generate a list of all ops from the last week (Thurs – Wed) and sort by emergency first. Export to excel
  5. Fill in the blanks for any pertinent details – e.g. bacteria grown, recent CRP, any unique post op plans etc.
  6. Delete any ops that don’t need to be shown from your finalised list (uncomplicated removal of metals, scopes, wound debridements – except PJI stuff which needs to be shown)

The resident will prepare all the xrays based on your finalised list

  • Show only pre-op worst XR/post-op XR except where the CT adds further info (e.g. in smashed #s, DRUJ injuries, subtle NOFs etc) or MRI is required (e.g. kiddy septic arthritis/OM)

The bosses prefer the following information only, except in interesting or complex cases or where further explanation is required (e.g. suspicious for NAI, unclear decision making based on XR alone etc.)

“This is a 55 year old male who underwent an ankle ORIF for this trimalleolar ankle fracture dislocation. This was done by James, assisted by Mr Mammen”

Paediatrics

Spica cast application protocol for trauma

Important Research

THR Surgical Approach RCT