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Curriculum standards

Entrustable Professional Activities

LG11: Acute care and procedures

Learning Goal 11

Acute care and procedures

Assess and manage acutely unwell paediatric and neonatal patients

This activity requires the ability to:

  • assess seriously unwell paediatric and neonatal patients, and initiate management
  • lead and perform effective paediatric resuscitation
  • plan, prepare for, perform, and provide aftercare for procedures expected of a general paediatrician, as listed in this EPA
  • manage ongoing care of acutely unwell paediatric and neonatal patients suitable for the inpatient ward and not needing intensive care
  • recognise and respond to clinical deterioration
  • escalate care where appropriate
  • participate in and, where appropriate, lead the resuscitation team
  • liaise with paediatric intensive care or neonatal intensive care units, retrieval services, and referral centres
  • safely prepare and handover acutely unwell patients at change of shift or change in patient status or location
  • communicate with family and carers regarding acute situations and plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise immediate life-threatening paediatric and neonatal conditions and critically unwell patients, and respond appropriately
  • prepare for, and perform, effective advanced paediatric life support and neonatal resuscitation
  • recognise and respond to clinical deterioration
  • assess, diagnose, and initiate management of acute undifferentiated clinical presentations
  • select investigations that exclude or diagnose critical patient issues
  • manage acutely unwell children and neonates suitable for the inpatient ward and not requiring intensive care
  • perform common procedures confidently and consistently, such as:
    • lumbar puncture
    • manual intermittent positive pressure ventilation via bag mask and T-piece
    • nasogastric tube placement
    • paediatric and neonatal cannula insertion
    • sterile urine collection via suprapubic and/or catheter
  • troubleshoot and manage patients with difficult intravenous access
  • demonstrate knowledge and skills in safe airway management on a mannequin and/or patient, such as:
    • endotracheal intubation
    • laryngeal mask and oropharyngeal / nasopharyngeal airway insertion
  • demonstrate knowledge and skills on a mannequin and/or patient in:
    • intercostal catheter insertion
    • intra-osseus needle
    • needle thoracostomy
    • umbilical venous catheterization
  • demonstrate knowledge of the principles and complications of midline, percutaneous long line (PICC) and central venous access insertion, and, where appropriate, practice insertion
  • demonstrate knowledge of the role for point of care ultrasound (POCUS) in diagnostic and procedural applications, and, where appropriate, practice on phantom models and/or patients
  • manage patients, in liaison with subspecialty teams, with:
    • central venous access devices
    • gastrostomy tube
    • other in situ medical devices
    • PICCs
    • ventriculoperitoneal shunts
  • recognise and effectively manage complications arising during and after procedures
  • initiate care of seriously unwell paediatric and neonatal patients requiring surgery and/or transfer to intensive care unit
  • initiate ventilation and inotropic support of paediatric and neonatal patients, with support from appropriate intensive care specialists or emergency staff
  • systematically identify causes of acute deterioration in health status
  • develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events
  • optimise medical management before and after operations, where appropriate
  • effectively manage acute pain and distress
  • demonstrate knowledge and skills in procedural pain management, such as sedation and analgesia, as well as non-pharmacological strategies
  • document treatment given without consent in an emergency according to local guidelines

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • recognise seriously unwell patients requiring immediate care
  • initiate paediatric and neonatal resuscitation as indicated
  • identify potential causes of current deterioration, and comply with escalation protocols
  • facilitate initial tests to assist in diagnosis
  • develop management plans for immediate treatment
  • document information to outline the rationale for clinical decisions and action plans
  • assess patients and identify indications for procedures
  • consider risks and complications of procedures
  • demonstrate knowledge and skills in:
    • lumbar puncture
    • manual intermittent positive pressure ventilation via bag mask and T-piece
    • nasogastric tube placement
    • paediatric and neonatal cannula insertion
    • sterile urine collection via suprapubic and/or catheter

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use closed-loop and clear communication with other health care team members during resuscitation and escalation
  • facilitate early sensitive communication with patients during escalation and resuscitation to allow shared decision making
  • explain procedures clearly to patients, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
  • accurately document procedures in clinical notes, including informed consent, indication for the procedure, medicines given, aseptic technique, difficulties encountered, and aftercare
  • liaise appropriately with paediatric and neonatal intensive care specialist and retrieval services
  • provide clear and effective clinical handover during change of shift or change in patient status or location

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate communication skills to sufficiently support the function of multidisciplinary teams
  • communicate with patients in a timely and appropriate manner
  • provide timely and safe handover during escalation and transitions of care
  • explain the process of procedures to patients without providing a broader context
  • discuss postprocedural care with patients
  • complete relevant patient documentation

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • set up all necessary equipment required for procedures, and consistently use universal precautions and aseptic technique
  • confirm patients’ identification, verify the procedure, and, where appropriate, the correct position / site / side / level for the procedure

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • comply with safety requirements of the health service

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • maintain up-to-date certification in advanced paediatric life support and neonatal resuscitation
  • participate in multidisciplinary practice of resuscitation skills, including simulation where available
  • seek guidance and feedback from supervisors and other health professionals to reflect on clinical deterioration or resuscitation events and improve future patient care
  • refer to and/or be familiar with relevant published procedural guidelines prior to undertaking procedures
  • organise or participate in in-service training on new technology
  • provide appropriate supervision to learners carrying out procedures

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • maintain life support requirements of the health service

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • negotiate health care decisions in a culturally appropriate way, considering variation in family structures, cultures, religion, and belief systems
  • use qualified language interpreters or cultural interpreters where appropriate
  • integrate culturally safe care of Māori and Aboriginal and Torres Strait Islander peoples into patient management
  • consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • practise cultural safety

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • apply ethical principles to life-saving treatments and patients’ and family members’ rights to decide management, including withdrawal of care
  • facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making
  • hold information about patients in confidence, unless the release of information is required by law or public interest

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • communicate medical management plans as part of multidisciplinary plans
  • establish, where possible, patients’ wishes and preferences about care
  • contribute to building a productive culture within teams

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise the need for escalation of care or patient transfer, and escalate to appropriate staff or services
  • use appropriate guidelines, evidence sources, and decision support tools
  • identify roles and optimal timing for diagnostic procedures
  • select appropriate investigations on the samples obtained in diagnostic procedures
  • reconcile conflicting advice from other specialties, and support shared clinical decisions in the presence of uncertainty
  • use care pathways effectively, including identifying reasons for variations in care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • involve additional staff to assist in a timely fashion when required
  • recognise personal limitation, and seek help in an appropriate way when required
  • assess personal skill levels, and seek help with procedures when appropriate

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • collaborate effectively with staff in the emergency department, paediatric and neonatal intensive care units, and other subspecialty inpatient units
  • demonstrate effective leadership and followership in acute care situations, including appropriate role allocation of team members
  • explain critical steps, anticipated events, and equipment requirements to team members before planned procedures
  • provide staff with clear procedural aftercare instructions
  • explain how to recognise possible procedural complications
  • identify relevant management options with colleagues, according to their level of training and experience, to reduce error, prevent complications, and support efficient teamwork
  • manage transitions of care of acute medical patients
  • check in and support team members’ wellbeing, and, where necessary, support psychological first aid and formal debriefing

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • collaborate with other team members, based on their roles and skills
  • ensure appropriate multidisciplinary assessment and management
  • encourage an environment of openness and respect to lead effective teams
  • involve appropriate team members to undertake procedures safely

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
  • prioritise patient care based on need, and consider available health care resources
  • collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • understand the systems for the escalation of care for deteriorating patients
  • understand the role of clinician leadership and advocacy in appraising and redesigning systems of care that lead to better patient outcomes