On-call doesn’t feel stressful because patients are complex.

It feels stressful because:

everyone wants you at the same time.

Within 10 minutes you might get:

“Doctor can you review chest pain?”
“Can you prescribe fluids?”
“Patient confused”
“Need cannula”
“Rewrite drug chart”
“Family wants update”

If you react to each bleep immediately, you will:

walk all night
achieve very little
miss sick patients
feel constantly behind

The goal is NOT to answer every bleep instantly.

The goal is:

Triage first. Move second.

Control the bleeps — don’t let them control you.

First rule (most important)

Never walk to a ward without information.

Always assess urgency first.

A 20-second phone conversation can save 20 minutes of unnecessary walking.

Step 1 — Slow down and ask questions

When the bleep goes off, don’t rush.

Call back calmly and ask focused questions.

Always ask:

What exactly is the problem?
What are the observations?
NEWS score?
When did this start?
Are they stable right now?
What do you need me to do?

This instantly tells you:
🔴 urgent
🟠 semi-urgent
🟢 routine

Without this, you’re guessing.

Guessing is unsafe.

Step 2 — Categorise immediately (traffic light method)

Mentally label every call.

🔴 RED — go now

Drop everything.

Examples:

chest pain
hypotension
hypoxia
reduced GCS
seizures
active bleeding
“looks really unwell”
“I’m very worried”

If a nurse sounds worried → treat as RED.

Do not delay.

🟠 ORANGE — soon

Needs review within 30–60 minutes.

Examples:

rising NEWS
AKI
abnormal bloods
new confusion
pain issues
IV access
fluids review

These wait until all RED jobs done.

🟢 GREEN — routine

Safe to batch or delay.

Examples:

discharge summaries
rewriting charts
routine bloods
paperwork
non-urgent prescriptions
family updates

These are not night emergencies.

They can wait hours.

And that’s okay.

Step 3 — Batch your jobs

Big efficiency hack most juniors miss.

Don’t run ward-to-ward randomly.

Instead:

✔ finish everything on one ward
✔ then move to the next

Example:

❌ Bad:
Ward A → Ward C → Ward B → Ward A

✔ Good:
Ward A (all jobs) → Ward B → Ward C

Less walking
Less brain switching
Less stress
Much faster

Step 4 — Don’t be afraid to say “after”

Very important mindset.

It is completely safe to say:

“I’m with an unwell patient — I’ll come after.”

You are not being rude.

You are prioritising safely.

Trying to please everyone immediately = unsafe care.

Good nurses understand this.

Step 5 — Keep one master list

Every time someone bleeps:

Write it down.

Do NOT rely on memory.

At 3am you will forget.

Always:

write job
ward
priority

Then decide order calmly.

Chaos reduces when everything is on paper.

Step 6 — Avoid “ping-ponging”

Ping-pong = running back and forth all night.

Example:

go for cannula
get bleeped
leave halfway
start something else
forget first job

This creates:

incomplete tasks
mental fatigue
stress

Finish one task properly before switching (unless RED).

Multitasking feels efficient but is actually slower.

Step 7 — Control interruptions when reviewing sick patients

When assessing an unwell patient:

It’s okay to:

silence phone briefly
ask nurse to hold calls
finish A–E properly

Half-reviewing a sick patient because of interruptions is dangerous.

Safety first. Bleeps second.

Step 8 — Reprioritise regularly

Every hour ask:

Who is sick now?
Any new REDs?
What actually matters next?

Priorities change constantly.

Reassessing keeps you focused.

Real NHS examples

Without triage

Walk to rewrite chart → meanwhile chest pain patient waiting → unsafe

With triage

Chest pain first → paperwork later → safe

Same tasks. Different order. Huge difference.

Common junior mistakes

❌ walking without asking questions
❌ treating everything as urgent
❌ starting paperwork early
❌ not writing jobs down
❌ running randomly between wards
❌ trying to “clear bleeps” instead of prioritising

These create stress, not the workload itself.

Senior doctor mindset

Calm registrars don’t move faster.

They:

ask better questions
group jobs
ignore routine noise
focus only on sick patients

Efficiency is about decisions, not speed.

Simple bleep algorithm

When bleeped:

1️⃣ Call back
2️⃣ Ask obs + problem
3️⃣ RED / ORANGE / GREEN
4️⃣ Write it down
5️⃣ Batch jobs logically

That’s it.

Simple. Safe. Effective.

Take-home concept

Bleeps are information, not instructions.

You decide the priority.

Not the bleep.

If you triage properly and batch your jobs, on-call feels organised instead of chaotic.

Control the bleeps — don’t let them control you.