When does a case need to be reviwed by a senior?(either directly or by discussion)

When a child is referred they will either be admitted or sent home
after adequate assessment of their problem. What constitutes
"adequate" assessment cannot be prescribed in advance for all
situations. The most important guarantee that any problem has been
adequately assessed will be the competence of the person doing the
assessment.

When you have assessed a problem you need to reflect on your level of
competence in dealing with the, a) child, b) the family and c) the
medical condition. If you are happy on all 3 counts then you need not
ask the Registrar for advice before making a decision about
admission/discharge. We do not want to have one rule for all
situations but would expect people to practice safely.

Whether an individual SHO is happy to make the decision will differ
depending on how long they have been in this post, whether or not they
have previous paediatric experience (and how much, of what?), how many
similar cases they've dealt with before and how good their clinical
and communication skills are. One SHO will ask them about a problem
where a second one wouldn't. This is what the Registrars themselves
will expect to happen.

At the beginning of a job, even experienced SHOs should at the very
least discuss all cases with the Registrar in order to allow them to
gauge your competence. How long this continues will then decided by
explicit discussion between individual SHOs and Registrars. If the
Registrar wishes to know about all cases, their view supersedes that
of the SHO.

We all have to recognize our levels of competence and practice safely.
If you feel any hesitation about making a decision, you should err
on the side of safety and discuss the child with the Registrar.

Remember that if a child has been referred in by their GP, it is a
courtesy to phone the GP and explain why admission was not necessary.

Consider also that some families have come a considerable distance and
may be exhausted. This would be a consideration for families from
anywhere west of Corwen.

This advice applies equally well to inpatients reviewed by SHOs
because of a change in their condition (either improvement or
deterioration).

Remember that you must always discuss a child with your Registrar if
your assessment is that the child has a serious condition, even if you
are entirely happy with your assessment and further management.

All of what has been said above can be translated to the dilemma of a
Registrar considering whether they need to discuss a child with a
Consultant. Consultants have the same sorts of decisions to make when
they consider whether they need to talk to a tertiary specialist.
Every doctor has to be reflective about their own competence and
practice safely. We hope that this guidance will both support you in
asking for help when you need it, but also practising your skills when
you are more experienced.