Paeds Cases · clinical-assessment-and-reasoning
Contested discharge and retrieval — structured clinical encounter
Structured encounter testing pre-discharge reassessment, caregiver concern, capability-matched disposition, I-PASS/ISBAR handover, retrieval decision and safety-netting teach-back.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Leo, 22 months, ED viral wheeze with incomplete discharge vitals, paternal concern that he is getting worse, and a regional hospital without on-site PICU if he deteriorates overnight.
Station brief (candidate)
You are the paediatric registrar in a regional hospital without on-site PICU. Leo, aged 22 months, presented with viral wheeze. After treatment, saturations are acceptable in air but the last blood pressure was not recorded. Father says, "He is getting worse." Bed management asks for discharge. You have 12 minutes at the bedside (simulated) and 5 minutes for discussion. [3]
References7ShowHide
- [1]Burvenich R, Bos DA, Lowie L, et al. Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428
- [2]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
- [3]Mills E, Lin P, Asghari-Jafarabadi M, et al. Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
- [4]de Vos-Kerkhof E, Geurts DH, Wiggers M, et al. Tools for 'safety netting' in common paediatric illnesses: a systematic review in emergency care. Archives of disease in childhood, 2016.PMID 26163122
- [5]Burvenich R, Heytens S, De Sutter A, et al. Towards an international consensus on safety netting advice for acutely ill children presenting to ambulatory care: a modified e-Delphi procedure. Archives of disease in childhood, 2024.PMID 38123917
- [9]Paydar-Darian N, Stack AM, Volpe D, et al. Improving Discharge Safety in a Pediatric Emergency Department. Pediatrics, 2022.PMID 36222092
- [14]Devita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Critical care medicine, 2006.PMID 16878033