Safe disposition, escalation, referral and safety-netting — branching viva

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]

Branch A — Keep and escalate

Examiner: "You decide to keep the child. Hand over to the night registrar." [2]

Strong candidate

• Uses I-PASS including synthesis by receiver. [2]
• States contingency if oxygen need or interaction worsens.
• Names senior/MET path.

Branch B — Contested discharge

Examiner: "Bed manager wants discharge. Give your safety-net if you were forced to justify home care." [5]

Strong candidate

• May refuse unsafe discharge.
• If discussing SNA: expected course, uncertainty, alarm signs, where/how to get help; verbal + written; teach-back. [5]
• Quotes Burvenich NMA carefully (process outcomes, limited certainty). [1]

Branch C — System question

Examiner: "What hospital changes reduce discharge-related harm and handoff errors?" [2] [9]

Strong candidate

• Discharge checklist, discharge-vitals huddle, scripted instruction review. [9]
• I-PASS: medical errors −23%, preventable AEs −30%. [2]
• Family-activated escalation and concern capture. [3]