Prioritising Clinical Tasks

SJT Textbook: Prioritising Clinical Tasks

Prioritising Clinical Tasks MSRA

This guide covers the essential skill of Prioritising Clinical Tasks MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate the ability to filter a chaotic task list through the lens of “Patient Safety First.”

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Prioritising clinical tasks means ordering your work to minimise harm and maximise benefit. In practice, this means treating the most unwell or time-critical patients before routine or administrative jobs, rather than simply doing tasks in the order they appeared on your list. ABCDE, NEWS2, sepsis red flags, chest pain, stroke and critical lab results all point towards problems where delay is dangerous.

The SJT tests whether you can rapidly scan for life or limb threats, act on time-critical results, and create a visible plan (for example, Now/Next/Later) with clear ownership and deadlines. Good answers show you using the whole team, delegating safely and escalating early when your capacity is exceeded.

Continuity and documentation are part of prioritisation. High-scoring options make sure that prioritisation decisions, escalation attempts and outstanding tasks are documented and handed over so that no one assumes a job is done when it is still outstanding.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Scan the list for life or limb threats first (airway, breathing, circulation, new neuro deficit, major bleeding, NEWS2 triggers).
2. Identify time-critical windows (for example, sepsis antibiotics, hyperkalaemia treatment, suspected ACS, stroke pathways) and place these at the top of the plan.
3. Create a visible Now/Next/Later list or board, assigning an owner and deadline for each task.
4. Escalate early to the registrar, consultant, nurse in charge or site manager if acuity and workload exceed safe capacity.
5. Delegate routine or lower-risk tasks to competent colleagues using SBAR, confirming what is needed and by when.
6. Re-triage regularly (for example, every 20–30 minutes), updating the plan as new information, results or bleeps arrive.
7. Act immediately on critical results or alert calls from the lab or radiology and record your actions.
8. Document key decisions, escalation, outstanding jobs and safety-netting clearly in the notes and handover.

Most traps ignore acuity, delay time-critical care, avoid escalation, or create unsafe delegation; high-scoring options keep sickest-first logic and clear shared plans.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Let us put this on a Now/Next/Later plan with named owners, deadlines and clear escalation thresholds.”
* “I am calling the registrar and nurse in charge because this workload and acuity feel unsafe.”
* “Can you take these lower-risk tasks if I hand them over using SBAR while I review the chest pain and hyperkalaemia now.”
* “I will document today’s prioritisation decisions, outstanding tasks and who to contact if there is any deterioration.”

P = Physiology first (ABCDE, NEWS2, red flags)
R = Results critical (labs, ECG, radiology alerts acted on promptly)
I = Involve team (use colleagues and supervision)
O = Owner for each task (named person)
R = Review plan regularly (Now/Next/Later board)
I = Intervals set (deadlines and escalation thresholds)
T = Track and document actions and delays
Y = Yes to escalation when capacity is unsafe

📋 QUICK FAQ

What if everything feels urgent at once?
Anchor yourself in ABCDE and NEWS2, then look for time windows (for example, sepsis bundle, chest pain, stroke, hyperkalaemia). Tasks that prevent immediate harm or deterioration come first; routine paperwork and non-urgent reviews come later.

Can I prioritise by who complains loudest or arrived first?
No. First-come-first-served or noise-based prioritisation is unsafe and unfair. You must use clinical risk, time-critical harm and clear reasoning to set the order of work.

What should I do when two high-risk tasks clash?
Call for help and split roles. For example, you may review the highest risk patient while a competent colleague starts protocol treatment for the other; involve the registrar and nurse in charge, and document your decisions.

Is it acceptable to leave at the end of a shift with jobs undone?
Yes, if you clearly hand over prioritised outstanding tasks with owners, deadlines and escalation thresholds, and document this. You are not required to finish every task personally, but you must ensure safe continuity.

How often should I re-prioritise?
Re-check your plan whenever new results, bleeps or deterioration occur, and at regular intervals (for example, every 20–30 minutes on a busy take). Prioritisation is dynamic, not a one-off decision.

📚 GMC ANCHOR POINTS

* Providing good clinical care and responding to risk, including acting promptly when a patient’s safety, dignity or comfort is at risk (GMC Good medical practice 2024).
* Using resources effectively and proportionately to maximise patient benefit (Good medical practice sections on resource use).
* Delegating tasks and making referrals safely, ensuring that colleagues have the necessary skills and supervision (Good medical practice, delegation).
* Keeping clear, accurate and timely records and ensuring continuity of care at handover (Good medical practice, records and continuity).
* Raising concerns where workload or system pressures risk patient safety (GMC guidance on raising and acting on concerns).

💡 MINI PRACTICE SCENARIO

You are the only SHO covering two wards at 18:00. Jobs include: a bleeper call for new chest pain with dynamic ECG changes, a lab alert that potassium is 6.4 mmol/L in another patient, sepsis antibiotics overdue on a third patient, three discharge TTOs, and several routine blood tests for tomorrow. The nurse in charge tells you she is worried about safety due to staffing levels.

Best action: Prioritise reviewing the chest pain with ECG changes and initiating ACS management, while urgently arranging hyperkalaemia treatment and sepsis antibiotics via escalation and safe delegation, and creating a visible Now/Next/Later plan that is documented and shared.
Why: This focuses on the highest-risk problems and time-critical treatments, uses the team and escalation to create capacity, and leaves a clear written plan, aligning with GMC duties on safe care, delegation and continuity.

🎯 KEY TAKEAWAYS

✓ Use ABCDE, NEWS2 and time windows to rank tasks by risk, not by order received.
✓ Make a visible Now/Next/Later plan with named owners, deadlines and escalation thresholds.
✓ Escalate early when acuity and workload exceed safe capacity.
✓ Delegate lower-risk tasks to competent colleagues using SBAR and clear briefs.
✓ Re-triage regularly as new information appears, adjusting your plan dynamically.
✓ Document key decisions, critical results, outstanding tasks and handover plans.

🔗 RELATED TOPICS

* → Time & Resource Management
* → Escalation & Raising Concerns
* → Delegation & Supervision
* → Working Under Time Pressure
* → Handover & Documentation

📖 FULL PRACTICE QUESTIONS

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

You are an FY2 covering the medical admissions ward. Within five minutes you receive multiple requests: a nurse reports a patient with new chest pain and ST changes on ECG; the lab phones with a potassium of 6.3 mmol/L; a patient with suspected sepsis has not yet received antibiotics; three families want updates; and there are several discharge summaries to complete before tomorrow morning.

Options:
A. Start writing discharge summaries so that the next day’s ward round is quicker.
B. Go to the chest pain patient immediately, assess using ABCDE, review the ECG and start ACS management, asking the nurse in charge to inform the registrar.
C. Ask a competent colleague to begin treating the hyperkalaemia according to protocol while you assess the chest pain patient, and request they bleep you with any concerns.
D. Phone the families first to reduce complaints and then see the sickest patients.
E. Create a Now/Next/Later list, placing chest pain, hyperkalaemia and sepsis antibiotics in the Now column, then share it with the team and allocate owners.
F. Ignore the lab alert for potassium because the patient is not currently complaining.
G. Tell the nurse in charge there is nothing you can do about workload and carry on working through the list in arrival order.
H. Decide not to document your prioritisation decisions because it will take too long.

Example SJT — Rank 5 (best → worst)

It is 19:00 on an acute medical ward. Your outstanding tasks are: review a patient with NEWS2 6 and rising oxygen requirement; give overdue IV antibiotics to a patient with suspected sepsis; chase a CT report requested earlier for a stable headache; complete two discharge letters; and update one family about a stable patient. The registrar is available by phone but busy in ED.

Options:
A. Review the NEWS2 6 patient immediately, then ensure sepsis antibiotics are administered promptly, phoning the registrar with an SBAR summary, and asking a competent colleague to chase the CT report and start discharge paperwork.
B. Complete both discharge letters first so that you feel more in control of your list, then move on to the unwell patients.
C. Call the family first so they do not complain, then work through jobs in the order they were added to the list.
D. Ask the healthcare assistant to “keep an eye on” the NEWS2 6 patient while you complete administrative tasks.
E. Wait to see if the registrar becomes free and do nothing until they arrive.

Options:
A. Review the NEWS2 6 patient immediately, coordinate antibiotics and escalation, and delegate routine tasks.
B. Complete discharge letters before seeing any unwell patients.
C. Call the family first, then follow arrival order.
D. Ask an HCA to watch the NEWS2 6 patient while you focus on admin.
E. Do nothing until the registrar is free.