Managing Multiple Demands

SJT Textbook: Managing Multiple Demands

Managing Multiple Demands MSRA

This guide covers the chaotic reality of Managing Multiple Demands MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate the ability to create order from chaos, using a single, unified list rather than scattered notes.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Managing multiple demands means channelling all competing inputs (bleeps, calls, results, relatives, bed requests) into one structured system instead of juggling them in your head. You then triage by clinical risk and benefit, assign clear owners and deadlines, and set escalation thresholds so that safety is never left to chance.

It matters because parallel interruptions and hidden work queues are classic sources of omission errors, missed deterioration and delayed time-critical treatments. The SJT tests whether you can build a simple, visible plan that everyone understands, protect focus for high-risk steps like prescribing and consent, and batch low-value tasks for efficiency.

High-scoring options show a single queue with ODT (Owner, Deadline, Threshold), short focus windows for critical tasks, timeboxed sprints for routine work, and early escalation when safe capacity is exceeded. Low-scoring options rely on chaotic multitasking, multiple private lists, answering every interruption instantly, or delaying escalation to “avoid bothering” seniors.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Direct all inputs to a single visible queue or board with ODT on every item (prevents tasks being lost).
2. Triage tasks by urgency, benefit and harm if delayed, not by noise or who shouts loudest.
3. Assign a named owner, a realistic deadline, and an escalation threshold for each task.
4. Protect focus windows for high-risk steps (for example, insulin prescribing, defibrillation, signing complex consent).
5. Batch low-value or similar tasks (for example, discharge letters, non-urgent callbacks) into short, timed sprints.
6. Use a simple bleep protocol: non-urgent calls returned at agreed times; urgent issues via SBAR immediately.
7. Escalate early to the nurse in charge, registrar or site team when queue length or acuity exceeds safe capacity, and document this.
8. Capture snapshot notes or photos of the board at key pivots and handover, so continuity does not rely on memory.

Trap answers favour speed, juggling and silence over visible structure, risk-based triage, shared ownership and timely escalation, which is the opposite of what the SJT rewards.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I am prescribing insulin now; hold non-urgent bleeps for five minutes and SBAR me immediately if anything is life-threatening.”
* “Let us batch results calls for the next ten minutes, then regroup and re-triage the board together.”
* “Our queue has breached safe thresholds; I have escalated to the registrar and site team and documented the capacity risk.”
* “I have updated the board and taken a snapshot so the on-call team can see owners, deadlines and outstanding risks.”

Queue one – funnel all demands into a single list
Urgency triage – rank by risk, benefit and harm if delayed
Escalation thresholds – define when to call seniors or site
Uninterrupted focus – protect high-risk tasks from interruptions
Execute batches – timebox low-value work into sprints
Make records/Escalate – document the snapshot and raise concerns

📋 QUICK FAQ

What should go on the single queue?
Everything that demands clinical attention or action: bleeps, relative queries, results, callbacks, discharge tasks. Each entry needs an owner, a deadline and an escalation threshold to avoid drift and duplication.

How do I respond to relatives when I am in the middle of a high-risk task?
Acknowledge their concern briefly, explain you are in the middle of a critical task, give a specific callback time, and ensure their question is added to the queue with ODT. This respects them while preserving safety.

How do I handle two urgent issues at the same time?
Split roles: you take the higher-risk decision point, and ask a competent colleague to manage the other urgent task according to protocol, with clear SBAR and a defined escalation threshold. Both tasks should sit on the same queue.

When should I escalate workload?
Escalate when there are multiple deteriorating patients, repeated breaches of time-critical windows, or when the team cannot find a safe regroup time. Clearly state the risks and the support you need, and record the conversation.

Is it acceptable to ignore bleeps to “catch up”?
No. Instead, use a simple bleep protocol: non-urgent calls are queued for scheduled callbacks; urgent issues are triaged immediately with SBAR. Ignoring bleeps can miss deterioration; structuring them keeps safety central.

📚 GMC ANCHOR POINTS

* Putting patient safety first and working within your competence and limits (GMC Good medical practice 2024).
* Working effectively with colleagues, delegating clearly and ensuring understanding and oversight (GMC Delegation and referral).
* Keeping clear, accurate and timely records, including during busy periods and at handover (GMC Recording information).
* Raising and acting on concerns when system pressures or workload may compromise patient safety (GMC Raising and acting on concerns).

💡 MINI PRACTICE SCENARIO

On an evening take, you are the only SHO covering a busy medical ward. While you prescribe insulin for DKA, the phone rings with a non-urgent discharge query, a relative approaches asking for an update, and a bleep reports a patient with NEWS2 6. You currently have a written list in your pocket and the nurse in charge keeps a separate whiteboard.

Best action: Protect the prescribing step, ask the nurse to hold non-urgent calls and relative queries for five minutes, log all new demands on a single visible queue with ODT, then attend or assign the NEWS2 6 patient immediately and escalate to the registrar if capacity is unsafe.
Why: This creates one shared queue, protects a high-risk prescribing step, responds promptly to deterioration, and uses escalation rather than private lists and juggling, aligning with GMC standards on safety, delegation and raising concerns.

🎯 KEY TAKEAWAYS

✓ One visible queue with ODT beats multiple private lists.
✓ High-risk steps need protected focus, not multitasking.
✓ Batch low-value tasks into short sprints when safe.
✓ Early escalation is safer than silent overwork.
✓ Documentation of the queue and plan underpins safe handover.
✓ The SJT rewards structure, not heroics.

🔗 RELATED TOPICS

* → Working Under Time Pressure
* → Prioritising Clinical Tasks
* → Time & Resource Management
* → Handover & Documentation
* → Escalation & Raising Concerns

📖 FULL PRACTICE QUESTIONS

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

You are the medical SHO on an acute ward. Within two minutes you receive: (1) a bleep about a patient with NEWS2 7, (2) a phone call from a GP chasing non-urgent results, (3) a relative at the nurses’ station wanting an update, and (4) a nurse asking you to sign several routine drug charts. The ward currently uses a whiteboard, but you also keep a personal list in your pocket.

Options:
A. Keep your pocket list separate and add new jobs there while asking the nurse to update the whiteboard independently.
B. Stop what you are doing and answer each interruption as it arrives, without writing anything down, to “keep things moving”.
C. Direct all new tasks to a single visible queue on the ward board, adding an owner, deadline and threshold to each.
D. Attend the NEWS2 7 patient immediately and ask a competent colleague to start time-critical actions while you review and escalate.
E. Ask the healthcare assistant to give clinical advice to the GP on the phone so you can focus on the unwell patient.
F. Agree specific times later in the hour to batch routine discharge queries and non-urgent callbacks, and log these on the board.
G. Decide not to call the registrar because “everyone is already stretched” and try to manage alone.
H. Take a quick photo of the updated board once you have triaged and assigned tasks, and upload it to the handover folder.

Example SJT — Rank 5 (best → worst)

You are on-call for the medical wards. The ward has a long list of outstanding jobs. Two patients have NEWS2 6 and 7 respectively, antibiotics are overdue for one sepsis patient, and there are numerous discharge summaries waiting. The nurse in charge looks worried. There is no agreed threshold for when to call the site team.

Options:
A. Move all jobs onto a single ward board with ODT, prioritise the deteriorating patients and overdue antibiotics, protect focus for critical steps, and escalate to the registrar and site team because safe thresholds are breached.
B. Answer every bleep immediately, switch tasks frequently, and keep all priorities in your head so you can “respond flexibly”.
C. Focus solely on discharge letters for an hour so you can “clear the backlog” before seeing the sick patients.
D. Ask the healthcare assistant to review one of the NEWS2 6 patients and decide what treatment they need while you write notes.
E. Continue working from your own private list without using the ward board, and avoid escalation because seniors are very busy.

Options:
A. One queue with ODT, risk-based triage, protected focus and escalation.
B. Answer all interruptions instantly and juggle tasks mentally.
C. Do routine discharge paperwork before reviewing unwell patients.
D. Ask an HCA to review a deteriorating patient and decide treatment.
E. Use a private list only and avoid escalation.