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.

SAQ 2 — Rural retrieval ISBAR and equity (10 marks)

A rural ED has a 3-week-old with fever and poor perfusion. You have started oxygen, access and antibiotics. The family speaks limited English. You must call the tertiary retrieval service. [2] [5] [6]

Tasks

1. Script an ISBAR retrieval call (6 marks).
2. List four communication elements required for safe transfer and language access (4 marks).

Model answer

ISBAR

• Identify: name, role, hospital, patient identifiers/age.
• Situation: critically unwell neonate with suspected sepsis needing urgent retrieval/PICU; time-critical.
• Background: 3 weeks, fever, poor perfusion; treatments given (oxygen, access, antibiotics); current physiology in plain terms.
• Assessment: septic shock / time-critical infection until proven otherwise; local capability exceeded.
• Request: accept for retrieval; advice on further stabilisation; confirm ETA and destination; leave callback number.

Safety elements

• Residual risk and contingency during wait; what must not delay transfer (non-essential imaging).
• Matched written/electronic summary with weight, allergies, drugs given, devices.
• Professional interpreter for family updates; do not use siblings as interpreters.
• Closed-loop confirmation of acceptance, destination and who updates the family.