Shared-care planning across primary, secondary and tertiary care — formative SAQs

SAQ 1 — Open-loop multi-level care (10 marks)

An 8-year-old with epilepsy sees a tertiary neurologist, a local paediatrician and a GP. Medicines were changed at tertiary clinic. The letter has not reached primary care. Mother carries both plans. The child is currently well. [1] [2]

Questions

1. Define shared care and contrast it with one-way referral and transfer of care. (3 marks) [2] [3]
2. Explain why relying on the parent as information intermediary is unsafe. (3 marks) [1]
3. Outline the essential elements of a shared-care plan and loop-closure actions you would implement now. (4 marks) [7] [8]

Model answer

Define (3). Shared care is deliberate co-management across levels with named owners and one coherent plan. One-way referral asks specialty for opinion or procedure without automatic co-management. Transfer of care moves responsibility to a new team with handover. This scenario is multi-level involvement without closed shared care. [2] [3]

Parent intermediary (3). Stille’s work shows parents often ferry information between primary and specialty care when clinician-to-clinician communication fails. This creates missed updates, wrong doses and delayed recognition. Families should receive plain-language copies, but must not be the default clinical messaging system. [1] [2]

Plan and loops (4). Write problems, goals, owners, emergency thresholds and review date. Reconcile the current medicine. Ensure tertiary advice reaches GP and local paediatrician. Assign owners and times for outstanding results. Teach after-hours pathway. Confirm the medical home remains whole-child owner for non-epilepsy care. [7] [8] [14]

SAQ 2 — Complex care and oncology shared models (10 marks)

A. A technology-dependent child is discharged after admission; mother remains sole coordinator of five specialties. B. Separately, a regional service redesigns childhood cancer care to reduce family travel. [9] [5]

Questions

1. List the core shared-care actions for the complex-care discharge. (4 marks) [9] [6]
2. Describe hub-and-spoke oncology shared care in principle. (3 marks) [4] [5]
3. State when acute stabilisation overrides shared-care redesign. (3 marks)

Model answer

CMC discharge (4). Name medical home and coordinator roles; shared written plan and emergency thresholds; medication/device reconciliation; closed-loop specialty tracking with owners and times; timed follow-up; support caregiver without unpaid full coordination dump. Hospital–community transition principles require usable updates, not diagnosis lists alone. [9] [6] [7]

Oncology hub-and-spoke (3). Tertiary protocol leadership with regional delivery of appropriate care, organised communication and case management so travel falls without losing safety. Not ad hoc local care without tertiary link, and not forced centralisation of every visit. [4] [5]

Acute override (3). ABCDE threats and emergency pathways first. Shared-care redesign happens after stabilisation, then the acute episode must update the multi-level plan. Structured handoff supports multi-team safety. [13]