First Safety Sweep
Before the bleeps start.
Before paperwork.
Before you sit down.
Do one thing first:
Find the sick patients early.
Not after they deteriorate.
Not when the nurse panics.
Early.
This 10–15 minute habit can prevent most overnight emergencies.
What is a Safety Sweep?
A Safety Sweep is a quick, proactive check of:
👉 Who is unwell right now or likely to deteriorate overnight
Instead of waiting for problems to come to you.
Think of it as:
“Where will tonight’s problems come from?”
Because they almost always come from the same patients.
Why this matters
Without a sweep, your night looks like this:
- Constant bleeps
- Running blindly between wards
- Discovering problems late
- Feeling reactive and stressed
With a sweep:
- You already know the sick ones
- Fewer surprises
- Better prioritisation
- Much calmer shift
It’s one of the biggest mindset shifts from F1 → SHO → Reg.
When to do it
Immediately after:
✅ handover
✅ writing your job list
Before:
❌ starting routine tasks
❌ paperwork
❌ discharge summaries
First 15 minutes = safety check.
Always.
Step-by-step: How to do a Safety Sweep
Keep it simple.
Don’t overcomplicate.
You’re not doing a ward round.
You’re scanning for risk.
Step 1 — Identify high-risk wards
Start with areas most likely to have sick patients:
Usually:
- HDU/step-down
- respiratory wards
- elderly care
- acute admissions unit
- gastro/liver wards
- oncology/haem (if covering)
These generate most night bleeps.
Go here first.
Step 2 — Speak to the nurse in charge
This is massively underrated.
Don’t open notes first.
Ask the nurse:
“Hi, I’m the on-call doctor tonight. Anyone you’re worried about?”
Nurses almost always know.
They’ll say things like:
- “Bed 5 looks worse”
- “Bed 8 BP dropping”
- “Bed 3 confused today”
- “Bed 10 might need review”
This saves you hours later.
Trust experienced nurses.
Step 3 — Quickly review the sickest patients
You don’t need full reviews.
Just a focused check:
- observations
- NEWS score
- oxygen requirement
- urine output
- latest bloods
- general appearance
Ask yourself:
👉 “Would I be comfortable if no one checked this patient for 6 hours?”
If no → review properly now.
Step 4 — Pre-empt predictable problems
Some patients almost always deteriorate overnight.
Examples:
- borderline sepsis
- rising lactate
- AKI
- COPD on oxygen
- DKA
- GI bleed
- confused fall-risk patients
- post-procedure patients
- anyone “just about stable”
These are your 2am bleeps waiting to happen.
Better to see them at 9pm calmly than 2am urgently.
Step 5 — Create a mini high-risk list
At top of your jobs sheet, write:
“High-risk tonight”
- Mr Smith – sepsis
- Mrs Khan – GI bleed
- Bed 12 – DKA
Now you know:
👉 who to check first if things get busy
This keeps your brain organised.
What a Safety Sweep is NOT
Not:
❌ full ward round
❌ detailed documentation
❌ reviewing everyone
❌ doing routine jobs
It’s just:
✔ quick risk scan
✔ identify problems early
✔ prevent emergencies
10–15 minutes max.
Real NHS examples
Without sweep
2am: “Doctor BP 80 systolic”
First time you’re seeing the patient
Chaotic
With sweep
You already saw them borderline at 9pm
Started fluids/antibiotics early
Much safer night
Same patient. Different outcome.
Common mistakes juniors make
❌ Waiting for bleeps
❌ Sitting down to paperwork first
❌ Assuming day team would tell you everything
❌ Not talking to nurses
❌ Discovering problems too late
On-call should be proactive, not reactive.
Senior mindset
Good registrars don’t look busy all night.
They look calm.
Because they:
- know where problems are
- check early
- prevent deterioration
Safety Sweep is a big part of that.
A simple routine to remember
After handover:
1️⃣ Check high-risk wards
2️⃣ Ask nurses who worries them
3️⃣ Review borderline patients
4️⃣ Write your risk list
5️⃣ Then start jobs
That’s it.
Take-home concept
Don’t wait for emergencies to find you.
Find them first.
A 10-minute Safety Sweep at the start of your shift can save hours of stress later — and sometimes save lives.
Proactive doctors have easier nights.
Reactive doctors run all night.
Choose proactive.