You are the sole medical registrar on take. The surgical FY1 bleeps you for help with a deteriorating post-op patient because the surgical registrar is in theatre. ED has 4 unseen referrals. What do you do?

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I'd manage this through **SPIES**.

**Seek information** — I would ask the surgical FY1 for an **SBAR**: situation, observations (NEWS2), background, my immediate concern. If the patient is peri-arrest I attend immediately and put out a 2222 call; if stable-but-deteriorating I can give telephone advice while reorganising.

**Patient safety** — both queues matter. The unseen ED patients have not been triaged by me; one could be septic. I would phone the ED nurse-in-charge for a NEWS2 sweep so I know if anyone is deteriorating in the queue, and ask my medical SHO to start clerking the lowest-acuity referrals with clear instructions to escalate anything abnormal.

**Initiative** — I would attend the surgical patient if NEWS2 ≥7, peri-arrest or diagnostic uncertainty. I would not 'just give phone advice' for a patient I have not seen if they are unstable.

**Escalate** — cross-cover does not transfer clinical responsibility. I would phone the **surgical consultant on-call** so they are aware their registrar is unavailable and a junior is managing a deteriorating patient. I would also inform my own consultant.

**Support** — afterwards I would debrief the FY1, thank them for escalating early, complete a **Datix** about the rota gap so the trust can address the surgical cover model, and reflect in my portfolio.

Cross-cover safety — surgical ward bleep while solo on the medical take

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