Escalating Clinical Concerns

SJT Textbook: Escalating Clinical Concerns

Escalating Clinical Concerns MSRA SJT

This escalating clinical concerns MSRA SJT guide explains how to recognise deterioration early, intervene within competence, escalate using SBAR, and ensure safe senior review.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Escalating clinical concerns means recognising deterioration or unsafe delay and getting someone with the appropriate competence and authority involved quickly. It prevents avoidable harm, ensures timely decision-making, and fulfils GMC duties to protect patients.

In MSRA SJT questions, high-scoring answers show speedy recognition of danger, timely calls to seniors, immediate safeguarding actions within your competence, structured communication (usually via SBAR), and contemporaneous documentation. Delays, vague messages, informal shortcuts, or ignoring red flags score poorly.

Escalation also includes escalating the chain if your first call fails and documenting what was done, whom you spoke with, and the agreed plan and timeframe.

Escalating clinical concerns MSRA SJT scenarios always prioritise early senior involvement.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Recognise risk promptly and act before deterioration accelerates.
2. Alert the correct senior or service using a live communication channel.
3. Intervene within your competence (oxygen, fluids, time-critical pathways).
4. Use SBAR with a specific request and timeframe for review.
5. Escalate if the first contact is unavailable or dismissive.
6. Ensure safe handover with agreed ownership and next steps.
7. Document findings, actions, contacts, plans, and timeframes clearly.

Delay in escalating clinical concerns MSRA SJT questions is heavily penalised.

Avoid anything that introduces delay, vagueness, or incomplete escalation.

SBAR communication is central to escalating clinical concerns MSRA SJT scoring logic.

💬 MODEL PHRASES (Use These in SJT Logic)

* “SBAR: Situation, Background, Assessment, Recommendation for urgent senior review.”
* “If unavailable, I will escalate to the on-call consultant or site team.”
* “I’ve documented actions, contacts, advice, and agreed review timeframes.”
* “I’ll call back if no review has occurred by the agreed deadline.”

Failure to persist with escalating clinical concerns MSRA SJT breaches GMC patient safety duties.

Recognise risk • Alert senior • Intervene now • SBAR request • Escalate barriers and document

📋 QUICK FAQ

What if my senior does not answer?
Reattempt, then escalate to the on-call consultant, site manager, or critical care outreach. Document attempts and times.

Is it acceptable to wait and review borderline observations?
Not if red flags exist. Act immediately: intervene, call early, and increase monitoring.

Can I bypass a dismissive senior?
Yes. Patient safety overrides hierarchy. Escalate respectfully and document your rationale.

What communication style should I use?
Use SBAR with clear facts, a concise assessment, and a specific request with timeframe.

What should documentation include?
Observations, your assessment, actions taken, people contacted, advice received, timeframes, and your name/role.

Documentation is mandatory after escalating clinical concerns MSRA SJT actions.

📚 GMC ANCHOR POINTS

• Take prompt action if patient safety is compromised (Good Medical Practice 2024, paras 17–21)
• Raise and escalate concerns appropriately (Raising and Acting on Concerns)
• Work within your competence and seek help when needed
• Communicate effectively for safe handover and continuity
• Maintain clear, accurate, and timely records

💡 MINI PRACTICE SCENARIO

A 78-year-old with pneumonia becomes hypotensive (87/50), tachypnoeic, and acutely confused. The registrar is scrubbed; outreach has not reviewed yet.

Best action: Intervene now with oxygen and fluids, escalate to the on-call consultant or site team using SBAR, and request urgent review.

Why: Immediate safeguarding plus escalation to someone available aligns with GMC duties to protect patient safety.

🎯 KEY TAKEAWAYS

✓ Escalate early when risk rises
✓ Use SBAR with a clear request and timeframe
✓ Intervene within competence to buy safety
✓ Escalate failures or dismissals promptly
✓ Document contacts, plans, and timeframes
✓ Prioritise patient safety over hierarchy or convenience

🔗 RELATED TOPICS

* → Incident Reporting
* → Safe Handover
* → Speaking Up / Whistleblowing
* → Managing Fatigue and Impairment

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

Scenario:
A patient admitted with suspected sepsis becomes hypotensive (84/50) and tachypnoeic. The medical registrar has not responded to two urgent calls. Nursing staff are concerned, and the patient’s lactate is rising. You are the only junior doctor immediately available.

Options:
A. Wait 30 minutes to see if the observations improve
B. Begin sepsis interventions within your competence and call critical care outreach or the on-call consultant
C. Send a message in the team chat and wait for replies
D. Ask the family to help find the registrar
E. Document later once the ward is quieter
F. Inform the nurse in charge and request additional monitoring
G. Repeat observations and escalate if still abnormal in an hour
H. Call the site team or duty manager and request urgent senior review

Example SJT — Rank 5 (best → worst)

Scenario:
On MAU, three issues occur at once:

1. Sudden chest pain with dynamic ECG changes
2. A febrile patient requiring fluids and antibiotics
3. Discharge paperwork for a stable patient
You are the only doctor present.

Options:
A. Attend chest pain immediately, activate acute coronary pathway, call the medical registrar, request cardiology input, and brief nurse to start sepsis screening for the febrile patient
B. Complete the discharge paperwork first, then review chest pain
C. Ask the HCA to keep an eye on the chest pain patient while you write notes
D. Start fluids and antibiotics for the febrile patient and call the registrar after lunch
E. Send the ECG to the team chat and wait for replies