How to manage the On Call- The Rule of 6Ds : The Mindful Surgeon

I was on-call with one of my SHO and we have been handed over a mountain of patients to see and jobs to do from the day take. Together, we managed the job list and did a comprehensive handover in the morning. My SHO asked me do I have a system for managing on-call; as they always seemed calmer and controlled.

I was asked a similar question by another colleague. I do not know how controlled my takes are, and it is not like I never make mistakes. But to think about it I do try actively not to run around like a headless chicken. Over the years, I watched my senior registrars and consultants who I considered efficient and incorporated those strategies.   In this blog post, we will explore  – the Rule of 6Ds – for prioritizing your job list during an acute take.

1. Designate:

The first step in effective job list prioritization is to clearly define the tasks at hand and who is to do them. As you receive information about incoming patients, try to get information to categorize them based on urgency and complexity. Make a list of jobs to do, and put it in a place where all teams can see what has been done and what needs to be done.

2. Delineate:

Establishing clear roles and responsibilities within your team is crucial for effective job list prioritization. Delineate tasks based on individual expertise and experience levels. This not only streamlines the workflow but also empowers each team member to contribute meaningfully to patient care. For example, I need to see the patient to decide to operate and consent, while my colleagues book the patient or do the preoperative investigations to get the patient ready for theatre.

3. Do it now:

Identify what needs to be done now. Patients in the ED are to be seen first, whether to go to the theatre first or do ward rounds.  All of them are equally important, however, we can only do one thing at a time. You cannot hold the theatre off, so while they send for the patient, make sure you see the patient and the scans first. Send your SHO to assess the patients in ED, while you start the ward round. If I have been handed over a mountain of referrals, I will go through the electronic notes, and scans and make a plan of action and divide and conquer.

4. Delegate:

Some tasks need to be done by you, but not every task requires your direct involvement. Delegate responsibilities based on the capabilities of your team members. This will empower junior colleagues to take on tasks and give a sense of responsibility, ensuring the workload is shared efficiently. However, delegation is not as same as duplication. For example, all patients need to be senior reviewed. So, if there is too much going on, I will clerk the patients and do the paperwork myself rather than duplicating the work, while my colleague will do other bits like drug prescribing.

5. Do It Later:

Amidst the urgency of an acute take, some tasks can be deferred without compromising patient care. Identify these tasks and schedule them for later completion. Make a list and set to visit them later, so that they are done. Not all ward referrals need to be seen at night , some advice can be given over phone.

5. Double Check:

After completing tasks or delegating responsibilities, follow up with a systematic double-check. Confirm that delegated tasks have been carried out as intended and that any tasks you have deferred are eventually addressed. Also, I have my work double-checking too, whether I requested the scan. I do this in the last hour, with the entire team while we prepare for the handover.

The Rule of 6Ds is an inspiring framework for managing tasks during an acute take. By defining, allocating, and managing tasks systematically, you can enhance efficiency, promote teamwork, and deliver optimal care to patients in urgent situations. Adopting this rule can help you achieve your goals and contribute to a more effective approach to acute take-job-list prioritization.