proc:proc_sop [RadRegWiki]

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====== PROC Standard Operating Procedure ======

This is a brief guide to how PROC night shifts should ideally run, but practice does vary.

==== Pre-Shift ====
  * It is worth checking that someone will be working from Derriford prior to a PROC shift a day or so in advance as this is required. The rota should be worked out so someone always is, but errors and changes can happen.
  * Decide where calls are getting sent - generally one person takes all calls, but sharing the load is also an option. You can either give the standard Derriford 32906 number and push calls from there elsewhere, or tell the various switchboards another number. Everyone should take a turn in a set of nights.
  * It as a good idea to create a MSteams chat to discus things within the team.

==== Starting a Shift ====

PROC shifts start at 2045, and there are a collection of things that need to be sorted at the start:

  * Call all the switchboards to inform them of the handover and relevant contact details
  * Contact the sites' on-call registrars to take handover and try to get them home.
  * Contact the sites' on-call radiographers and to set up lines of communication and check for any issues:


            * Derriford has a standing request that a teams chat is set up for each night
            * Torbay operates through the "Torbay CT" teams chat.
            * Truro adds you to or sets up a teams chat for the night.
            * Exeter radiographers generally want to be called - it is worth taking this number and pinning it in a group chat.
            * Barnstable radiographers vary between through switch and teams. 


There is an overlap built into the shift change over to allow for handover - generally most would aim to have all the housekeeping and calls sorted before 2100 so the on-call site regs can focus on clearing any significant backlogs after then if needed.

==== During the Shift ====

After the initial rush to sort out hand-overs and get everyone home, it's just a matter [[proc:ct_vetting|of vetting]] and reporting overwhelmingly CT scans with the occasional MR and XR. Imaging you need to report should be put in the PROCREP silo - but not all of it is with Derriford ignoring this entirely as they are special, so most people work from a day list. Make sure to check PROCREP from time to time however for those pesky NG lines.

When reporting on PROC shifts it is recommended you do not give advice regarding further investigations of incidental findings - describe the findings only, and add the rider "Advice on further management will be given in an addendum.". Even if you are post FRCR it is recommended that you PROV code the scan rather than give potentially wrong recommendations. This in practice varies, however unless you really know the relevant local protocol well err on the side of leaving it to the checker.

[[https://nhs.sharepoint.com/:w:/r/sites/msteams_e1797f/Shared%20Documents/General/PROCuments/General/PROC%20%20Recommendations%20for%20further%20investigation%20of%20incidental%20findings%202023.docx?d=w7c05047525074cb6a0c9ece58952b51b&csf=1&web=1&e=KW0W8r|Recommendations for further IX]]

It's generally a good idea to have the person on the phone to report relatively short scans such as CT heads as they lose less when they inevitably get interrupted that way. Don't stress too much if there are few scans to report, just take a moment to see if any of they need urgent reporting and prioritize those that do, but really most can wait a few hours if needed. Try to chill out and enjoy some interesting radiology, with relatively little dross.

==== Ending a Shift ====

In general, most registrars start to wind down after 0800 due to a) being very tired at that point and b) the day team being around in less than an hour, with priority placed on reporting the truly urgent imaging that needs a report now.

Due to the fact that at 0900 there normally isn't all that much urgent going on a hand back doesn't universally happen, but a few things may need to be phoned through to the day team: If any urgent scans, e.g. trauma scans are imminent that should be phoned through to the day team, and if any MRI requests have been accepted to happen first thing in the morning you need to get in touch with the relevant team to make sure they are aware [[proc:out_of_hours_mri|(more details here)]].

Handback contact details:
++++|
  * Derriford:
  * Truro: Call Hothub on 01872 255182
  * Exeter:
  * Torbay: Call the Torbay On-call mobile on 07717 484608
  * Barnstaple:
++++
==== Breaks ====

It is worth thinking about and discussing breaks early. There are places to sleep at most sites, and an hour or two can make a major difference. It is generally recommended that the most junior registrar gets the middle break so they are never alone if breaks overlap.

==== Ultrasound ====

The only expected ultrasound provision overnight is for Derriford for renal transplant ultrasound - you can if you really want to go above and beyond and do more, but it is worth being a cautious about this.

==== Useful Links ====


[[proc:ct_vetting|PROC CT Vetting]]

[[PROC:Out of Hours MRI|Out of Hours MRI]]

[[private:radiology_phone_book|Radiology Phone book]]

[[https://www.youtube.com/watch?v=iik25wqIuFo&t=1s|Free Coffee on PROC]]