Making a referral

An SBAR approach is a good system to ensure you communicate all details in a systematic way. Think about what the person you are speaking to will want to know, and have the notes, drug and nursing charts available so that you can answer any of their questions.

Introduction

• Explain your name, role and division
• Explain what you want from them (e.g. see a ward patient, give advice over the phone, take over a patient’s care, perform an investigation, or see a patient in clinic)

‘Hello, it’s Dr Smith here, the FY1 on call for medicine. I am phoning to ask if you could review one of our patients on the ward and consider them for transfer to the intensive care unit.’ 

Situation (core details)

• Patient details (name, age, hospital number)
• Patient location
• Major problem at the moment

‘The patient is called Alexander Steward, he is a 59 year old man on ward E1 whom I was asked to see because of hypotension.’

Background (admission and history)

• Admission details (if inpatient): date, admission reason, treatments
• Past medical history
• ± any other relevant aspects of the history, e.g. premorbid state

‘He was admitted 3 days ago for community acquired pneumonia, for which he is on amoxicillin and clarithromycin. He is normally fit and well, fully independent, and has a history of mild asthma which is normally well controlled.’

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Assessment

• Observations
• Examination findings
• Investigations received/pending
• Management so far

‘His blood pressure is currently 85/45, despite 3 litres of IV fluids over the last 2 hours. He has only had 3ml urine output over the last hour. He is oxygenating well and is not pyrexial.

On examination, he is drowsy and confused with cool peripheries and coarse right lower lobe crepitations on auscultation.

I have done an arterial blood gas which shows a lactate of 4.

I have also sent bloods and repeat cultures, although the results are not yet back.’

Recommendation

• Diagnosis/differentials
• Management plan 

‘I think he has septic shock and wonder whether he needs vasopressors to maintain his blood pressure. I would be grateful for your input as soon as possible.’