#SimBlog: The Difficult Referral
“18 y/o male with head injury from a cricket ball. His CT shows an extradural haematoma and you need to refer him to the neurosurgical team at another hospital...”
Observations
A – Patent
B – RR 12 Sats 100%
C – HR 78 BP 126/56
D – GCS E3 V4 M6 (13)
E – Bruising to Head
Clinical Findings
Right Sided Extradural on CT
Pearl bilat
No other injuries
Why We Simulated
Making a referral is an essential skill when working in the ED, and should be viewed in the same way as any practical procedure. If you are inexperienced or not properly prepared it can go badly. The difficult referral OSCE base can also feature in professional exams. Practice and feedback on your technique can be helpful, an example might be to complete a DOPs for making a referral.
We ran this scenario as part of a teaching session with the aim of highlighting some tips and some mistakes to avoid.
Before making any referrals it is worth considering the following:
Are you ready to make this referral?
Do you know who you are calling – is it the Consultant, the Registrar or the SHO (it can be very embarrassing to have woken the wrong person in the middle of the night!)
What is the outcome you are after – review in ED or admission?
Do you have all the relevant details – patient demographics, history, exam and results?
What are you going to say?
We use SBAR as a structure, you may use something else but it is important to have a structure in your head and to stick with it. This can be especially helpful if you are interrupted as it gives you a structure to fall back to. The following videos summarise how you can use SBAR.
Pitfalls to avoid
Don't forget to introduce yourself - it is a perfect time to use #Hellomynameis.
Remain polite – working in medicine can be stressful with lots of pressures on individuals, even if the person on the other end is being difficult it is important to understand that they could be having a really bad day and to remain courteous yourself.
If the conversation becomes especially challenging it is ok to say you are going to end the call and speak to your consultant/reg.
Remember to get the details of who you have spoken to and document your referral in the notes.
