Paeds Vivas · clinical-assessment-and-reasoning
Safe disposition, escalation, referral and safety-netting — branching viva
Branching viva from contested ED/ward disposition through caregiver concern, I-PASS handover, safety-netting content, retrieval and discharge-system design.
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Study tools
Target exams
RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
You are the evening paediatric registrar. A toddler treated for wheeze has acceptable saturations but incomplete discharge vitals. A parent says the child is getting worse. The examiner releases information in stages. Defend disposition, escalation, handover, safety-netting and system reasoning.
Station opening
Examiner: "Saturations are fine and the score is low. Why aren't you discharging?" [3]
Strong candidate (must-hit)
- Capability-matched disposition uses acuity, trajectory, social capability and system capability. [4]
- Incomplete discharge vitals are a safety gap. [9]
- Caregiver concern is an independent risk signal (Mills aOR 1.72 for ICU). [3]
- Low score is not a veto. [3]
Weak candidate
- "Score is green so home is fine."
- Ignores parent.
- No teach-back plan. [5]
References6ShowHide
- [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