On-Call Patient Review: FY Guide

A practical guide for FY doctors reviewing an unfamiliar patient on-call, covering ABCDE, observations, investigations, escalation, documentation and handover.

Being asked to review a patient you have never met is one of the most common — and most stressful — jobs on an FY on-call. You often arrive with limited background, a busy jobs list, and the quiet fear of missing something important.

This FY on-call guide walks through a calm, repeatable approach:

see the patient
get the clinical context
assess systematically
escalate early when needed
document clearly so the next doctor can continue safely

Before you leave the nurses’ station

When the bleep or nurse request comes in, take thirty seconds to clarify the ask:

Who is the patient (name, ward, bed)?
Why have you been asked now (pain, NEWS2 rise, low urine output, fall, abnormal bloods)?
How urgent is it — can this wait ten minutes, or do you need to go now?
What has already been done (repeat observations, oxygen started, ECG, bloods sent)?

Write it down. On a night shift, memory is not a safe system.

Look at the patient before looking at the computer

Foundation doctor speaking to and assessing an unfamiliar patient at the bedside — Before ordering investigations, look at the patient, listen to their story and establish what has changed.

When you arrive, introduce yourself, confirm identity with the wristband, and ask the nurse to stay if possible. Your first job is a rapid clinical first impression:

Does the patient look well, unwell, or critically unwell?
Are they speaking in full sentences?
What is their work of breathing, colour, and consciousness?
What does the patient (or nurse) say has changed?

Screens help — but they do not replace standing at the end of the bed.

Use an ABCDE approach for the acutely unwell

ABCDE assessment infographic for FY doctors reviewing an acutely unwell patient — For an acutely unwell patient, use an ABCDE approach, treat problems as you identify them and reassess after intervention.

If the patient is deteriorating, do not jump straight to the notes. Use a structured ABCDE assessment and treat problems as you find them:

A — Airway: Can they talk? Is the airway patent and protected?
B — Breathing: Respiratory rate, oxygen saturations, oxygen requirement, chest exam, work of breathing.
C — Circulation: Heart rate, blood pressure, capillary refill, fluid status, IV access, bleeding.
D — Disability: ACVPU/GCS, pupils, blood glucose, pain, focal neurology.
E — Exposure: Temperature, skin, wounds, calves, drains, focused exam guided by the complaint.

Reassess after every intervention. A NEWS2 trend is useful context, but your bedside findings decide urgency.

Get the clinical context quickly (BODEX)

Clinical information to check before reviewing an unfamiliar patient on call — A quick review of bloods, observations, medications, ECGs and imaging can help you understand an unfamiliar patient’s clinical context.

Once the patient is stable enough — or in parallel if help is with them — gather the background that makes an unfamiliar review safe. A simple mental checklist:

B — Bloods: Recent FBC, U&E, CRP, lactate, cultures, trends not just single values.
O — Observations: Latest set and the trend over the last few hours; what triggered the call.
D — Drug chart: Anticoagulation, insulin, opioids, antibiotics, allergies, missed doses.
E — ECG: If chest pain, syncope, electrolyte issues, or tachycardia/bradycardia.
X — X-rays / imaging: Chest X-ray, CT reports, and whether imaging is pending.

Also check: reason for admission, ceiling of care / DNACPR status if recorded, and who the parent team is.

Make a clear assessment and plan

After bedside review and notes, summarise in one or two lines:

What is the most likely problem right now?
What must be ruled out because it would be dangerous to miss?
What immediate actions are needed?
What can wait until the parent team / morning?

Order investigations only if they will change management overnight. Start treatment you are confident about (for example oxygen to target saturations, analgesia, fluids after senior discussion where appropriate), and set a clear review time.

Escalate early — use SBAR

FY1s are not expected to manage every problem alone. Escalate early if the patient is unstable, you are out of your depth, or the situation is not improving after initial measures.

When you call a senior, structure the referral:

Situation: Who you are, where you are, and the immediate concern.
Background: Admission reason, key history, DNACPR/ceiling if known.
Assessment: ABCDE findings, NEWS2, key results.
Recommendation: What you need — review, advice, or urgent presence — and by when.

Have the notes, observations, drug chart and results in front of you before you dial.

Document as if the next doctor has never met them either

Your entry should let another FY understand the case at 03:00:

Time of review and why you were called
History from patient/nurse and relevant background
Examination / ABCDE findings and observations
Key investigations reviewed or requested
Impression and differential
Plan with timescales, escalation thresholds, and who was informed

Update the jobs list and hand over unfinished issues at the end of the shift.

A simple on-call review checklist

Clarify the job and urgency
See the patient and form a first impression
ABCDE if unwell; treat and reassess
Check bloods, observations, drugs, ECG, imaging
Decide: treat / investigate / escalate / observe
Document and set a review time
Hand over anything outstanding

When should an FY escalate a patient?

Escalate promptly if the patient is haemodynamically unstable, has a rising or high NEWS2 with clinical concern, reduced consciousness, suspected sepsis with deterioration, chest pain with ECG changes, airway compromise, or if you are unsure and the situation feels unsafe.

Escalation is a safety behaviour, not a failure.

What should I check before reviewing a patient on-call?

Confirm identity and location, the reason for the call, latest observations/NEWS2, recent bloods, the drug chart (including allergies), relevant ECGs or imaging, admission diagnosis, and any documented ceilings of care. Then go to the bedside and assess the patient yourself.