FREE MSRA PODCAST QUESTION— SJT (Priority) 🎧
High-yield breakdown of a classic “competing bleeps” scenario: triage under pressure, early escalation, and safe delegation. 🧠⚡️
Clinical vignette
You’re the medical SHO covering two wards on an early evening shift when several demands arrive at once: (a) a 72-year-old with pneumonia is acutely dyspnoeic with SpO₂ 82% on air; (b) ED wants TTAs for a stable discharge “in 30 minutes”; (c) Radiology phones with a routine outpatient US query; (d) an FY1 asks you to check warfarin dosing before 18:00; (e) a relative requests an update via switchboard. The nurse in charge can assist; the medical registrar is busy but contactable; ALS/2222 is available.
Question
Select the THREE most appropriate actions to take now.
Options
Go immediately to assess the hypoxic patient with ABCDE, give oxygen per protocol, request observations and a VBG.
Call 2222/ALS or the medical registrar for urgent support while en route, giving a concise SBAR.
Ask the nurse in charge to pause/redirect non-urgent bleeps; inform ED TTAs will be delayed; document reprioritisation.
Prioritise writing the ED TTAs first because patient flow targets must be met.
Tell the FY1 to hold warfarin and you’ll review later, without assessing the patient.
End the radiology call by telling them to ask the GP instead, as it’s not urgent.
Ask the ward clerk to take the relative’s details and arrange a call-back later; ensure consent/ID checks before any update.
Advise the nurse to escalate to outreach/critical care only if the patient arrests.
ANSWERS AT THE END (scroll to end)
Brief explanation
Immediate safety first: Severe hypoxia (SpO₂ 82%) demands ABCDE, oxygen, monitoring and early gas (NEWS2/NICE/GMC).
Early escalation: Alert 2222/ALS or the registrar on the move; use SBAR to save time and share risk.
Prioritisation & delegation: Insulate non-urgent tasks (TTAs, routine calls, relative update) via the nurse in charge; communicate delays and document decisions for continuity and governance.
A bit more (from the episode)
Concurrent actions matter: Calling for help en route accelerates definitive care without delaying bedside assessment.
Professional tone: Don’t dismiss colleagues (e.g., Radiology); defer politely and route via the nurse in charge.
Relatives & confidentiality: Arrange a call-back with proper ID/consent rather than splitting attention during an emergency.
Avoid unsafe shortcuts: Remote warfarin advice without assessment is risky; defer safely and review properly.
Documentation protects patients and you: Record who was informed, what changed, and why.
Key takeaways
TRIAGE: Treat the sickest first (ABCDE) → Raise help early (2222/SBAR) → Insulate non-urgent tasks → Acknowledge delays → Guidelines (NEWS2/NICE) → Enter clear notes.
Patient safety > admin targets.
Communicate, escalate, document.
📎 More MSRA resources to accompany this episode:
#MSRA #MSRASJT#CopingUnderPressure #Prioritisation #ABCDE #NEWS2 #GMC #Teamworking#Escalation #SBAR #NHS
Correct choices (Priority — best three): 1, 2, 3
