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Two Acute Medical Registrars are on duty from 0800 to 2300 hours. During that period, these registrars share acute medical admissions equally, and also look after their own inpatients.
Additionally, one registrar/team covers surgical consults. The other covers arrest calls.
While on duty, acute registrars should not have any other commitments, such as outpatient clinics or day ward duties. Handover to the night registrars is between 2230 and 2300 hours.
The Night Surgical Registrar covers general surgery, vascular surgery, and paediatric surgery. Handover is between 0800 and 0900 hours. They also cover all acute admissions to the above services and any problems with inpatients that cannot dealt with by the House Officers.
The Cardiology Registrar is on duty from 1600 - 2300 hours on weekdays, and 0800 - 2300 hours on weekends and public holidays. The Cardiology Registrar looks after all cardiology inpatients and any acute admissions under this service. They also see Cardiology consults.
Typically, the registrar spends most of their time in the Emergency Department and Coronary Care Unit. They should contact the cardiologist on call before handover, and notify them immediately of any seriously unwell patients, or patients with ST elevation myocardial infarction to discuss if the patient is suitable for primary angioplasty or thrombolysis.
Handover to the night duty team is from 2230 - 2300.
On weekends a second Cardiology Registrar is rostered from 0800 - 1600 hours each day. Handover from daytime to evening is usually done by telephone.
Haematology Registrars do not take part in the Duty Medical Registrars’ roster on evenings and weekends, but are included in the roster for night duty.
On weekday evenings, the Duty Medical Registrar does not need to cover Haematology patients because the Consultant Haematologist takes the first call for enquiries relating to these patients. Overnight, Haematology patients are cared for by the Night HO 2 and (if necessary) by the Night Medical Registrar with the Consultant Haematologist on call.
The Haematology Registrars continue to cover Haematology patients on the weekends. If a simple problem arises, the Haematology Registrar might request that it be attended to by Duty Medical HO. This is to avoid an inappropriate call back.
There are three medical registrars on duty each evening and weekend:
MR1 primarily covers acute admissions and ward reviews of respiratory and gastroenterology patients. On Saturdays they cover respiratory ward rounds with the Respiratory Consultant. On Sundays they cover gastroenterology ward rounds with the Gastroenterologist.
MR2 primarily covers acute admissions and ward reviews of Neurology and Nephrology patients. They can be phoned for Infectious Diseases advice from other areas in the hospital (e.g. surgical). On a weekend, MR2 will start with the Nephrology ward round on Sunday, then move to the Neurology ward round. Saturday ward rounds will be done by the ward registrar, or by MR2 if they are on that service.
Stroke Thrombolysis and clot retrieval requires immediate input from the NNI registrar.
MR3 primarily provides support to the "admitting" registrar(s) for the acute medical registrars on duty for General Medicine. They work with the direction of the senior medical registrar to clerk in patients or review house officer admissions. The also cover non-acute general medical patients on the wards. During weekends they review non-acute patients. This comprises most of their work.
Registrars need to determine what problems exist in the hospital and co-ordinate their activities. For example, two registrars might both have been asked to see the same patient. Registrars must contact the Duty Medical House Officers at:
This position is filled on weekends and public holidays only. This registrar is responsible for reviewing identified medically complex surgical patients in the orthopaedic and general surgery wards.
There are two Medical Registrars on night duty providing cover for all medical inpatients and new admissions. Generally, Night Registrar 1 attends to general medicine admissions and ward work, while Night Registrar 2 attends to specialty medicine admissions and ward work. However, this is only a guideline. Registrars should share the workload if necessary to allow for an even spread.
Along with completing their out-of-hours duties, the participants in all the above medical rosters will contribute to the Clinical After-Hours team. The medical activities of each participant in the Clinical After-Hours team are coordinated by the Clinical Team Coordinator. Consequently, during out-of-hours work, the participant might be required to provide generic, appropriate medical care in a timely manner to any patient who requires the participant’s degree of expertise at that time.
The Oncology Registrar covers Oncology (both radiation and medical) and Palliative Care. The registrar is on call 1600 - 2300 weekdays and 0800 - 2300 weekends and public holidays. They are responsible for the care of inpatients under Oncology and for the assessment of patients whose attendance at ED has been arranged by Oncology. Patients who have self-referred or presented via ambulance will be assessed by the ED or general medical teams. However, they might be taken over by Oncology after discussion with the on-call consultant.
Topic Code: 10731
Acute Medical Registrar