Handover, referral and consultation in paediatrics — formative SAQs

SAQ 1 — Night ward I-PASS with residual risk (10 marks)

A 9-month-old with bronchiolitis is on high-flow oxygen. Work of breathing improved earlier but the infant is quieter now. Capillary blood gas is pending. The caregiver says the baby is “not himself.” You are handing over to the night registrar. ^{[1] [4]}

Tasks

1. Write a complete oral I-PASS handoff for this child (6 marks).
2. State two classic handoff failures this vignette risks, and how synthesis by the receiver prevents them (4 marks).

Model answer

I-PASS (must-hit points)

• Illness severity: watcher / potentially unstable respiratory trajectory — quieter after earlier high effort; not a low-risk “stable” label.
• Patient summary: 9-month-old with bronchiolitis on high-flow; earlier improvement then reduced interaction; caregiver concern present.
• Action list: reassess work of breathing and interaction now; chase/own the pending gas; escalate oxygen/support per local pathway if tiring; senior review triggers.
• Situation awareness / contingency: if effort rises, SpO2 falls, or consciousness drops → call senior/MET and prepare escalation; do not be reassured by a single prior improvement.
• Synthesis by receiver: night registrar restates severity, top actions, contingency and gas ownership; you correct gaps.

Failures and prevention

• Omitting severity/contingency or caregiver concern; pending result with no owner; sender monologue.
• Receiver synthesis forces restatement of those items before you leave, catching omissions.