Newborn preventive package before rural discharge — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar. Aria is 26 hours old and looks well. Parents want same-day rural discharge. Hearing is bilateral refer. CCHD screening is outstanding. Bloodspot is collected. Vitamin K was given. You have 12 minutes with the family and 5 minutes for examiner discussion. [8]

Information available on request

• Gestation 39+2, SVD, birth weight 3.4 kg, no antenatal cardiac concerns. [4]
• Examination: normal red reflexes, equal femoral pulses, hips stable, no murmur when settled. [8]
• When CCHD screening is performed during the station, foot SpO2 is in the algorithm fail range. [4]
• Family has one car; fuel limited; nearest echocardiography is at the regional base hospital. [8]
• Predischarge transcutaneous bilirubin is available if requested; no jaundice in first 24 hours. [14]

Tasks

1. Clarify screening status with the parents in plain language. [8]
2. Complete or arrange CCHD screening and act on the result. [4]
3. Counsel the hearing refer without over-calling deafness. [11]
4. Make a capability-matched disposition and safety-net plan. [8] [14]

Marking anchors

Must-hit

• Does not discharge on “looks well” alone. [8]
• Performs or obtains CCHD oximetry and treats fail as same-day pathway, not home observation. [4]
• Hearing refer → diagnostic audiology booking language. [11]
• Names incomplete/pending items and logistics for a rural family. [8]
• Jaundice safety-net and feeding advice. [14]

Merit

• Explains non-cardiac differentials for oximetry fail without losing cardiac urgency. [4]
• Uses teach-back. [8]
• Structures handover listing every screen status. [8]

Fail

• Discharges after failed oximetry because infant is feeding. [4]
• Tells parents the baby is deaf on the basis of screening alone. [11]
• Leaves bloodspot/hearing/oximetry without an owner. [8]